Biennial Health Conference 2011 - Ministry of Health

Report of the 1st Biennial Health Conference 7-9 November 2011 

Ministry of Health 

Royal Government of Bhutan 

Report of the Biennial Health Conference 

7-9 November 2011 

Mongar, Bhutan 

“Strengthening Health Systems for Quality Care”


CONTENTS 

PRE-CONFERENCE November 7, 2011........................................................5 

MAIN CONFERENCE NOVEMBER 8, 2011...............................................19 

DAY 3PLENARY SESSION NOVEMBER 9 2011.......................................35 

RECOMMENDATIONS..................................................................................45 

ANNEXURE........................................................................................................57 

AGENDA FOR BIENIAL HEALTH CONFERENCE 2011........................77 

BHC 2011-PARTICIPANT LIST.....................................................................84 

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PRE-CONFERENCE 

November 7, 2011 

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11 TH FIVE YEAR PLAN FRAMEWORK- Mr. Kado Zangpo, Offtg. CPO, PPD 

The Chief Planning Officer, 

PPD presented the 11 th Five 

Year Plan framework highlighting 

the Key Results Areas 

identified by the Gross 

National Happiness Commission 

(GNHC). 

The presentation also highlighted 

on the planning and 

coordination issues and the 

need to strengthen coordination 

between the center and 

Dzongkhag while planning. 

He also solicited the forum on 

the ambiguity in the role of BHU planning and management and sought views 

on whether it should be decentralized or taken up at the central level as in the 

case of Ministry of Education. 

The forum highlighted that the key result areas do not address important challenges 

that the health system faces. And the need for GNHC to give the Ministry 

the actual committed budget for 11 th FYP to enable the Ministry to prioritize and 

plan activities was felt necessary. Concerns were also raised on the need to allocate 

more funds for preventive and promotive healthcare as it is an important 

aspect for an efficient health system. 

The conference recommended PPD to 

a. Broaden the key result area in addition to the ones identified by GNHC. 

b. Explore ways of getting committed budget allocation for the 11th FYP to 

do realistic planning which will also enhance performance and clinical 

auditing. 

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HEALTH FINANCING AND 11 TH FYP –Mr. Jayendra Sharma, PPD 

Mr. Jayendra Sharma, PPD made a presentation on “Financing Healthcare in 

Bhutan” highlighting the need to have a self reliant system. The forum was apprised 

on how financing impacts cost control, the different methods of healthcare 

financing and the national policy. He further elaborated on the key findings from 

the Bhutan National Health Accounts 2009-2010 and Healthcare costing exercises 

which were carried out by the Ministry. The need for sustainability initiatives by 

increasing the pool of resources and the ways to minimize the resource leakages 

was also discussed. 

Concerns were raised with regard to the definition of basic and free health care 

in the National Health Policy. The forum was informed that the definition of free 

and basic health care was discussed in detail and was intentionally removed due 

to many reasons, with the key reason being that the term basic is dynamic and 

subject to change with time and evolution of healthcare. 

With regard to charging non-Bhutanese, directives from the conference was 

sought by the participants. It was clarified that non-Bhutanese can be categorized 

into many categories such as teachers who do not earn high salary, skilled and 

semi skilled workers hired for Hydro power projects, and tourist who are covered 

by health insurance. 

Concerns were raised whether it is possible to compare BHU and referral hospital 

in terms of health expenditure where the services provided are different. It was 

also submitted that Indent control should be done at every level. 

With regard to outsourcing, increasing efficiency and cost saving, it was elucidated 

that outsourcing will bring in efficiency but will take some time. To make health 

system sustainable, it was raised that the system should allow mixed players and 

encourage Public Private Partnership model. Permitting private participation 

in the provision of specialized services in selected diagnostic services was also 

discussed.. Ministry should review the current existing guideline for charging 

non-Bhutanese to make it more convenient and uniform. 

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SCHOOL HEALTH SERVICES- Mrs. Sonam Palden, PO, DoPH 

The Program Officer informed the forum that Comprehensive School Health Program 

(CSHP) has been renamed as Adolescent Health Program since October 

2010. The forum was also briefed on the key area of focus and objectives of the 

program which included, among others, early diagnosis and follow up of diseases. 

Following issues were highlighted by the program: 

Low coverage of health services in the schools 

Weak referral system and follow up after the school visits 

Inadequate health promotion 

The forum noting the increase in adolescent health issues such as teenage pregnancy, 

acknowledged the initiative taken by the program by broadening the aspects 

of the program to cover adolescent issues targeting both formal and informal 

sectors. 

Concerns surrounding the coverage and frequency of school health checkups in 

view of the inadequacy of budget were deliberated. The forum also deliberated on 

the need to prioritize the schools by focusing on schools located in remote areas 

away from health facilities rather than covering all the schools. Considering that 

one third of the Bhutanese population are in school, and further acknowledging 

the impact of school health program on early diagnosis and timely referral of 

cases from the very remote schools of the country, the forum committed to uplift 

the activities currently undertaken. The frequency of visit was however, left to 

the districts to decide depending on the convenience of the district. 

The forum also agreed on the need to explore alternatives such as involving 

NGOs in order to reach the unreached population particularly the informal sector 

and further to mainstream coverage. The forum was informed that life skill 

based education program would train all the teachers so that they inculcate the 

knowledge into the students. 

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FOLLOW UP ON STATUS OF DISEASES SURVEILLANCES IN THE DISTRICTS- 

Mr. Sonam Wangchuk, Head, PHL 

The Head of the PHL, made a presentation on the disease surveillance system in 

the country. He apprised the forum on the importance of disease surveillance in 

order to design public health interventions. He outlined some of the initiatives 

taken by the PHL in strengthening disease surveillance in the country and the 

weaknesses in the surveillance system that needs to be rectified. 

The presentation highlighted on the following objectives: 

• Sensitize district health authorities on importance of surveillance system 

• Reinforce notifiable disease and other disease surveillance 

Following the presentation, the Chairperson reiterated the importance of disease 

surveillance in public health interventions and called for issues and outcomes 

from the forum. The forum commented that the health workers must be empowered 

to analyze and interpret data collected in the fields which will further assist 

in policy developing or strategy building right at the grass root levels. The forum 

agreed that surveillance should happen in the different health units in the facilities 

throughout the country and not only in the Public Health Laboratory. 

Further, the forum raised that the accountability of data exchange/reporting 

should be established for both the senders and reporters and that the data lost 

or not received by the MOH should be reported immediately instead of the last 

minute. The forum also questioned the need to report data on diseases which are 

not prevalent and non-epidemic in nature. 

On the new monthly water quality monitoring modality, the forum raised that 

the frequency of monitoring had a lot of budget implications, and proposed that 

the water monitoring be reinstated to the previous modality of pre and post monsoon 

testing. In response to the proposals, the Director DOPH/Co-Chair apprised 

the forum that the new modality was in-line with the surveillance manual and it 

should be referred as it has inputs from all the stake holders including the health 

staff from the districts. And that the guidelines in the manual have been developed 

as per international standards and no changes to it shall be entertained. 

The Co-Chair also apprised the forum that robust surveillance is important to 

stop potential epidemics as it surfaces. The chairman apprised the forum that 

complacency of surveillance system has been noticed in a series of cases across 

the country, thus it shall be revived and reactivated. 

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Recognizing the importance of surveillance system, disease control and rapid 

response to outbreak, the conference recommended to device mechanism to oversee 

the adherence to the surveillance manual by all health workers. To further 

enhance the system, the research unit will need to train health workers in data 

collection and analysis. 

INSTITUTION OF SURVEILLANCE OFFICERS AT THE DISTRICT- 

Mr. Tandin Dorji, CPO, DoPH 

Mr. Tandin Dorji, CPO, CDD proposed for the need of surveillance officers at the 

districts to help HMIS and DoPH in the collection and analysis of data. He stated 

that at present the Ministry is having a poor reporting on notifiable diseases 

which resulted in a series of deaths caused by outbreaks such as the outbreak 

of Anthrax in Zhemgang, Meningitis in Thinleygang and the frequent rabies 

outbreaks across the country. 

The forum suggested that the BPH students could be appointed as surveillance 

officers upon completion of their course. However, concerns were raised over the 

need to have clear career ladder for these surveillance officers and on the need 

to create new positions as per RC SC’s BCSR and PCS. Further, sections of the 

forum argued that health being an evolving field, new job categories will surface 

and some old job categories such as BHWs and ANMs will be phased out. There 

being no consensus on the need for surveillance officer from DHOs, the matter 

will be put on hold. 

ADDRESSING HEALTH DATA GAPS- Mr. Tshering Jamtsho, HMIS 

Mr. Tshering Jamtsho, Research Officer, HMIS presented the Health Information 

System (HIS) conceptual framework highlighting on the principles and enablers 

for improved health data for better health. He also emphasized on the apparent 

health data gaps which undermine informed decision making for planners and 

health decision makers. He further emphasized on the quality of health data at 

two levels, i.e. BHU and District level. 

It was informed that ICD 10 related reporting from the health centers is not very 

reliable as the doctors tend to forget to assign ICD codes while issuing diagnostic 

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reports. Misreporting also happens as the doctors’ handwritings are not always 

readable. The forum was requested to give directions on who should code the 

ICD codes on the prescriptions. 

The need to standardize the coding of ICD 10 in the BHUs and hospitals was 

raised as an important task that needs to be reinforced. The forum also highlighted 

on the need to integrate four character ICD 10 code into Hospital Information 

System to enhance specific disease coding. 

Concerns were also raised with regard to the completeness of the HMIS data. 

The forum highlighted that a good sustainable reporting system should be used 

instead of surveys. 

For better functioning of health system, the conference emphasized to improve 

data quality and completeness at all levels including hospitals. Hence, conference 

reiterated to fill the approved vacant post of Medical Record Officers and 

Medical Record Technicians in major hospitals immediately and to explore the 

possibility of recruiting Medical Record Technicians in all hospitals. The conference 

also recommended to train health workers on ICD 10 coding and expedite 

the use of HIS as early as possible. 

STRENGTHENING PMTCT AND PROCUREMENT OF ARV DRUGS- 

Mr. Namgay Tshering, PO, DoPH 

The session began with a comprehensive presentation by Mr. Namgay Tshering, 

NACP, DOPH. The presentation focused on three agendas which are as follows: 

1. Integrating the PMTCT programme with the MNCH programme 

2. Elimination of congenital syphilis by 2020 

3. Functioning of the MSTF 

The forum commented that the deadline for elimination of congenital syphilis by 

2020 contradicted to the MDG deadlines. 

Learning from the presentation about the need to re-model the MSTF, the forum 

raised that if the tasks of the MSTF was skeptical, it was not necessary to continue 

the activities conducted by MSTF and reallocate resources into other priority areas. 

With regard to the MSTF seed money, the forum proposed that the seed 

money should be raised to a minimum of Nu. 5,00,000 and a maximum of Nu. 

10,00,000 as the MSTF has to conduct activities related to a series of programmes. 

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Further, the forum also raised that the issue with the improper functioning of 

the MSTF was not because of the seed money but due to the constant transfers 

of MSTF member from one district to another. The forum also commented that 

the MSTF should be used for other activities related to health and the lead role 

should be played by the Health Ministry. 

The conference- recommended integrating PMTCT with MNCH and improve 

on VCT in every MCH session. The conference acknowledged the critical role of 

MSTFs particularly in the areas of inter-sectoral collaboration. It was recognized 

that MSTF should expand its role to involve other public health issues. 

Meanwhile, health sector would continue to take the lead role in conducting 

MSTF activities. 

BRIEFING ON THE ROLES AND RESPONSIBILITIES OF EMTD- 

Dr. Karma Lhazeen, CPO, EMTD 

The Chief Program Officer, EMTD appraised the forum on the mandates of the 

division highlighting on what the division has been doing since its establishment 

in June 2009. The forum was also appraised on the mandates of the two major 

wings of the division, the Essential Drugs Program (EDP) and Health Technology 

Assessment (HTA) (initiated in later half of 2009). It was informed that the 

division is guided by National Drug Committee (NDC) and Health Technology 

Assessment Panel (HTAP). The need to establish a close link between Health 

Technology Regulation (HTR), Health Technology Management (HTM) and HTA 

in order to enable best use of the health technologies was raised. The forum was 

further briefed on the detailed protocol for assessing a proposal on establishing 

a new technology. Lack of expertise to assess the proposals received were one of 

the main issues faced by the division. 

MANDATES OF BNCA AND ITS LINKAGES TO MINISTRY OF HEALTH – 

2. Research, Surveillance and Recording 

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Mr. Kinley Dorji, ED, BNCA 

The Executive Director, BNCA, apprised the forum that the BNCA and 

MOH should work together on the following broad issues: 

1. Information, Education, Training and Awareness


3. Tobacco Dependence and Cessation. 

Following his presentation, he apprised 

the forum on some of the specific components 

of the broader issues, namely, 

technical assistance in controlling the 

spread of Blood Borne Viruses amongst 

Intravenous Drug Users, Human Resource 

support at the rehab centre and 

Collaborations to build human resource 

capacity. 

The forum also sought for a clearer picture on how to go about with the referral 

of drug addicts to different treatment centers. The ED, BNCA explained the referral 

system of various clients to the treatment centre was done referring the Referral 

Guideline and the Implementation Framework of the NDPSSA Act, 2005. 

As in the case of the tie up between the MOH’s Health Information and Service 

Center and BNCA’s Drop In Centre, the forum proposed for a possible tie up 

between the Youth Centers in some of the districts and the BNCA’s help centers. 

Further with regard to the proposals made by the ED, BNCA, the Chairman apprised 

the forum that the NACP will develop guideline on the prevention of 

Blood Borne Viruses amongst drug users. He also proposed to develop detox 

centers at the Regional hospitals. 

The forum acknowledged the proposal of the ED, BNCA on the need for MOH to 

closely collaborate with the BNCA in delivering its mandates. 

PLANNING EVIDENCE BASED ANNUAL CYCLE OF QUALITY IMPROVEMENT 

FOR THE HEALTH SERVICES IN BHUTAN – 

Mr. Dechen Chophel, CPO, QASD 

The Chief Program Officer presented on the annual cycle of Quality Improvement 

for the Health facilities of Bhutan by setting quality priorities and using regular 

data collection to monitor quality improvements. He emphasized on applying a 

reliable design framework to improve quality of care in the health facility. 

It was apprised that after the investigation by the Anti-Corruption Commission, 

reluctance has been shown by the health workers to join the team for quality 

assurance/inspection to inspect equipments and drugs. The need for an executive 

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order on who should comprise of the quality inspection team was also raised. 

The forum also highlighted that QASD should not forget the field reality while 

conducting Quality Assurance activities. 

POPULATION BASED CANCER REGISTRY AND STILL BIRTH STUDY 

APPRAISAL – 

Dr. Ugyen Tshomo, Gynecologist, JDWNRH 

A presentation on the proposed population based cancer registry was made by 

Dr. Ugyen Tshomo, Gyanecologist, JDWNRH. She apprised the forum on the 

need for the registry and the prerequisites for a good cancer registry. She emphasized 

on the importance of the registry in epidemiological studies. 

Dr. Ugyen apprised the forum on the cancer control activities in the country, 

particularly focusing on the Human Pappiloma Virus prevention activities. She 

also informed on the status of work on the cancer registry so far and the pending 

tasks. Approval for instituting the cancer registry was sought from the forum 

and stated that the registry should preferably be functioning from 2013. 

Dr. Ugyen concluded her presentation by apprising the forum on a study conducted 

by Dr. Phub Dorji on the cause of still births. 

Noting the rising cancer incidence in the country and poor documentation, the 

conference- emphasized on the development of a cancer registry by LSRD program 

at JDWNRH and to explore the possibility of starting population based 

cancer registry system. 

USING ICT TO ENHANCE QUALITY CARE SERVICE IN BHUTAN – 

Ms. Gaki Tshering, Head, ICT 

The Head, ICT Unit presented on the brief overview of the mandate of the Unit. 

The forum was informed that the Unit serves as an enabler guided by Bhutan 

Information and Communication Technology Policy (BIPS) developed by the Department 

of Information Technology. In addition, the forum was also apprised on 

the six impactful ICT initiatives developed and functioning within MoH which 

are Bhutan Health Management Information System (BHMIS), Bhutan Medical 

Supply Management System, Rural Telemedicine Project, SAARC Telemedicine 

e- Network, Hospital Information System (HIS) and Health Help Center (HHC). 

Current trend and statistics on the use of HHC was tabulated and presented. 

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SENSITIZATION ON THE HHC AND AMBULANCE ISSUES- 

Dr. Nar Bdr, CEO, HHC and Mr. Ngawang Dorji, CPO, DMS 

Dr. Nar Bdr presented on the Health Help Center (HHC) highlighting the objectives 

of HHC and Ambulance dispatch process during emergencies. 

Mr. Ngawang, DMS presented on the issues with regard to ambulances including 

status of ambulances as of November, 2011. He also informed that by end of 

November, all Hospitals will get Maruti van as the utility vehicle. He submitted 

to the forum that the replacement of spare parts of the ambulances to be done by 

the Ministry. 

Submissions on the need to explore the possibility of securing extra budgetary 

support for ambulances were made to the forum as the cost of fuel and maintenance 

was on rise. 

SENSITIZATION OF MEDICINAL PRODUCT REGISTRATION- 

Mr. Sonam Dorji, Drug Controller, DRA 

The Drug Controller apprised the 

forum on the mandates and various 

procedural requirements for 

registration. He briefed the forum on 

the need for the regulation of drugs 

with emphasis on the need to check 

for counterfeit medicines in the 

market. 

Issues such as proposals from Health 

Assistants (HAs) and nurses to 

open private pharmaceutical shops 

were raised. The forum was informed that the license is only issued to those 

personnel who are trained by the DRA on pharmaceutical protocols. The Co- 

Chair responded to the appraisal by proposing if DRA could allow Health 

Workers who have experience in dispensing medicines at the BHUs to undergo 

short pharmacy competency trainings so that they are eligible to establish private 

pharmacies. 

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UPDATE ON THE BMHC REGULATIONS – 

Dr. Pandup Tshering, Registrar, BMHC 

The Registrar, BMHC appraised the forum on the recent updates of BMHC regulations 

such as the following: 

1. Medical Fitness certification by ACOs restricting to ACOs placed in the 

border district hospitals only and not all the ACOs in the country 

2. Quality of in-country trainings – the forum was briefed on the minimum 

standards developed in order to maintain the quality of the in-country 

trainings. 

3. CME- the forum was informed on the credit requirements as per the 

BMHC Regulations 2005. The forum was informed that 65% of the 

registered health professionals have not acquired any or less than 15 

CME credits while only 18% of the health professionals have acquired 

more than 30 CME credits. 

4. Health Camps- a notification that all health professionals involved in the 

camps are registered with BMHC though none of the camps conducted 

earlier were registered. 

The Registrar raised issues concerning the Regulating the existing private health 

facility; Registration of Imtart health professionals and Practice by non-health 

professionals. 

The forum agreed that any health professional who wishes to practice in Bhutan, 

irrespective of which sector they are practicing, should be registered under 

BMHC as mandated by the Act. The forum agreed that MoH is equally responsible 

in regulating the health practices particularly illegal practices while Council 

is strictly mandated to regulate on the health professionals practicing in Bhutan. 

The Council was directed that its mandates should be governed by the Act which 

has been approved by the Parliament. 

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MAIN CONFERENCE 

NOVEMBER 8, 2011 

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INAUGURAL SESSION 

The BHC 2011 began on the November 8, 2011 with “Zhungdrel Phuensum 

Tshop” and the traditional 

“Marchang” ceremony by 

Dasho Dzongda, Mongar. 

His Excellency Lyonpo Zanglay 

Dukpa, Honb’le Minister 

of Health graced the inaugural 

session of the Biennial 

Health Conference 2011 as 

the Chief Guest. The Hon’ble 

Members of the Parliament, 

senior officials of the Royal 

Government, representatives 

of bilateral and multilateral 

donor agencies, Dasho Dzongdas from the eastern dzongkhags, and other invitees 

were also present. 

WELCOME ADDRESS – 

Dr. DORJI wangchuk, Offtg Secretary 

Following the formal inauguration of the conference, the Offtg. Health Secretary 

delivered the welcome address. In his address, he apprised the forum about 

uniqueness of this year’s conference as it was the first one to be held biennially. 

He briefly apprised the forum on the objectives of the Biennial Health Conference. 

He paid tribute to Her Majestry the Royal Gand Mother,Ashi Kesang Choden 

Wangchuck, Leaders who worked in the health sector in the country and enhanced 

it over the years. He also paid tribute to the health workers all across the 

country who bear the brunt of various hardships in delivering healthcare to the 

people. While talking about the successes and tributes in the health sector, he 

also stated that some of the challenges in the sector must be noted and rectified. 

Further, he apprised the forum that with the evolving trends in the healthcare 

delivery system, the pressure on the health staff to deliver is forever mounting 

which at times puts the ministry in a fix due to the lack of time and resources to 

respond during needy moments. The detailed welcome address is annexed (Annexure 

2). 

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INAUGURAL ADDRESS – 

Hon’ble Chief Guest, Lyonpo Zangley Dukpa 

Hon’ble Minister informed 

the forum that BHC is held 

in the eastern Dzongkhag 

for the first time with the 

purpose to reflect upon 

and review policies and 

programmes in the context 

of progress, problems and 

prospects concerning the 

Ministry in particular and 

the country in general. 

Hon’ble Minister highlighted 

on the major achievements 

made in health sector 

over the last three years. He 

mentioned that Bhutan is 

considered as a country with the best primary healthcare systems in the world 

with universal health coverage. The award from GAVI in 2010 for being the best 

performance in immunization programme, drastic reduction in the under-five 

and maternal mortality rates, achievements of MDG goals and increased life expectancy 

for Bhutanese population were also highlighted. Hon’ble minister reiterated 

that these achievements have been possible because of the farsighted leadership 

of our Monarchs, enduring efforts of the health workers and the generous 

assistance from donor agencies. 

His excellency also acknowledged the challenges faced by the the health sector 

such as scrutiny from the media, shortages of drugs and medical supplies, sustainability 

of free health care, double burden of diseases,etc. 

Hon’ble Minister expressed his appreciation to all the health workers and mentioned 

on the need to be kind, caring, respectful and compassionate, which are 

termed as humanistic medicine. The detailed welcome address is annexed (Annexure 

1) 

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VOTE OF THANKS- 

Dr. Ugen Dophu, Director-DoPH 

The Director, DOPH concluded the inaugural session by thanking the guests, 

coordinators and the participants. 

FOLLOW UP OUTCOME OF AHC-2009- 

Mr. Ugyen Wangchuk, PPD 

The business session began with a presentation on the follow up work done on 

the outcomes of the previous Annual Health Conference. 

The 2009 AHC outcome follow-ups were presented to the forum. 

OVERALL PROSPECTIVE OF HEALTH SYSTEM- 

Dr. DORJI wangchuk, Offtg. Secretary 

The Offtg. Secretary apprised the forum on the evolution of healthcare in Bhutan. 

He also highlighted on the challenges faced by the Ministry and the way forward. 

Following the presentation, the forum raised that the hospitals in the different 

districts shall generate their visions and mission statements in order to draw a 

clear direction towards achieving their goals. The forum made special reference 

to the progress in the education system where the schools draw up their visions 

and mission statements which facilitate in accelerating their progress. 

The forum apprised the ministry that by 2015, the UN has predicted that the world 

will be seeing a rapid increase in the number of ageing people and proposed that 

the ministry must act proactively to gear towards serving the older generation. 

The Offtg. Secretary apprised the forum that the ministry recognizes the fact that 

the ageing population will be a major challenge for the health sector and that a 

study is currently being conducted in Khaling to explore on how the ageing issue 

can be integrated into the primary health care system. He apprised the forum 

that the ministry has also started training staffs on geriatric healthcare. 

The forum proposed for the procurement of utility vehicles for transporting the 

dead bodies to the place for cremation desired by the deceased’s relatives. The 

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forum apprised the ministry that the vehicle can be fueled by the party of the 

deceased while the vehicle maybe provided free by the facility as the cabbies 

charge high fares. Hon’ble Lyonpo directed the district health personnel and the 

respective Dasho Dzongdags to figure out ways to procure the utility vehicles 

without full financial support from the government. 

ADOPTION OF AGENDA 

The agenda was adopted as proposed. 

PARALLEL SESSIONS 

COMMITTEE A- Chaired by Dr. DORJI wangchuk, Offtg. Secretary 

HRD MASTER PLAN AND STRATEGY – Ms. Yangchen, Chief HRO, HRD 

Mrs. Yangchen presented on the status of Health HR, implementation of HR 

master plan, performance management as per PCS, recruitment and selection 

procedures, objectives of in-country training unit and promotion issues. Some of 

the major challenges highlighted were shortage of HR, stagnation of promotions, 

coordination issues with in-country training, brain drain and difficult to keep 

pace with the ever changing technology. Reviewing of career ladder, mobilization 

of fund for implementing the HR Masterplan and conducting training need 

assessment vs. the HRD Masterplan were among the way forward adopted by 

the division. 

The forum deliberated on the following issues: 

• Limited career advancement opportunities for Health Assistants/nurses/ 

technicians due to qualification factors. 

• Up-gradation of all BHWs , HAs and ACOs irrespective of age 

• It was submitted that all nominations and transfers should be routed through the 

Dzongkhag HRC with proper outcome. 

• It was submitted that MBBS graduates were placed in Grade 7 in the PCS but as 

per the cadre system, they were placed in Grade 5 in the past. There is a general 

feeling of unfair treatment among the MBBS doctors. 

• Only few health professionals have received fast track promotion due to lack of 

timely information. 

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• The Uniform allowances for female HAs and caretakers were not given in some 

health facility because there are no written directives. 

• The position title of ADHOs is still reflected as HA under the PCS. The positional 

title of DHO could be reviewed under PCS. 

• In view of shortage of Doctors in the district hospitals thus hampering the quality 

care, concerns on whether additional ACO or HA could be provided were 

submitted. 

• It was submitted that district doctors work for 24 hours and they should be 

incentivized. DMOs have bigger responsibilities as compared to the MO while 

they have the same level of entitlement. If certain incentives such as waiving out 

house rent could be put in place. 

• Day off- for nurses and health workers in the casualty. 

• Discrepancies in the title of the female HAs and ANMs- paramedical and nursing 

practice 

• Lots of students have ENT problem in Tashigang while there is no ENT technician. 

The following were the comments from HRD with regard to the above issues: 

• It was clarified that there has not been much transfer proposals unless on the basis 

of medical ground. Promotion stagnation has been discussed in the recent HRC. 

Ground work has been already done and the proposal would soon be submitted 

to RCSC. Nothing can be done on the increment as it is under the jurisdiction of 

Ministry of Finance. 

• Up-gradation could be one of the measures to promote to next level. 

• As per BCSR rule, the limit on the age for up-gradation course cannot be done 

away, while HRD could try proposing to RCSC. 

• The transfer of health workers have been decentralized to the district level and 

the Ministry will transfer based on their outcome. 

• With regard to the ADHOs position, HRD informed that the issue has been 

discussed and the appeal has been already submitted to RCSC. RCSC has 

informed that it requires to be discussed further. 

• HRD will discuss the issues of entry grade for doctors with RCSC 

• To address the Brain Drain, Ministry is working on retention policy by recruiting 

specialist on contract basis with higher remuneration. 

• HRD Master plan will be the basis of deploying the right person in the right 

place. 

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• It was informed that Health Professionals do not receive Medals and only few 

of them have received fast track promotion. The Chair requested the district 

colleagues to submit names of those who have made outstanding achievements 

to the Ministry. 

Recognizing HR as the key driver for health service delivery, the conference recommended 

strengthening the HR system in terms of rational deployment and 

fair and transparent HR development. The implementation of PCS and its impact 

were discussed in detail, and following were recommended strongly: 

a. Review the entry grades for professionals with MBBS and specialist 

qualification; 

b. Review and develop a mechanism of providing on-campus accommodation 

for health workers in order to provide uninterrupted emergency services and 

for ensuring uniformity or provide compensation. This is also in line with the 

Accelerating Bhutan’s Socio-economic Development (ABSD) initiatives; 

c. Explore provision of uniform/dress allowances for all clinical workers; and, 

d. Review and restructure the office of the District Health Officer in consideration 

of, among others, the population and geographic size of the Dzongkhag. 

IMPACT ANALYSIS OF HEALTH PROMOTION – 

Mr. Wangchuk Dukpa, PO- DoPH 

After a brief presentation the program officer, the forum deliberated on the following 

issues: 

• Whether health promotion carried out adequately? 

• Whether community is fully involved? 

• How can inter-sectoral collaboration be enhanced? 

• Does ICB have the full capacity to carry out its roles and responsibilities? In what 

ways ICB is mandated to support the districts? How do we revamp the roles and 

responsibilities of ICB and adjust with the current situation. Will it suffice with the 

establishment of health promotion program. 

• How do we increase the health literacy rate? 

Considering the existence of social determinants which would impact health the 

forum noted that there is a requirement for synergies as health cannot work in 

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isolation. The forum emphasized the need to strengthen the health promotion 

aspects in collaboration with the other sectors. It was also submitted that there is 

a need for mapping of all the health promotion activities which are planned by 

various programs and then to make strategic plan on implementing in collaboration 

with the health promotion unit. 

Suggestions were also made on provision of extensive training on inter personal 

communication skills for any health personnel joining health in consideration to 

the importance of health promotion and behavioral change. 

The forum, considering the benefit health sector has availed through the collaborative 

approach it has instituted agreed to work even more closely with all the 

sectors. In order to further the collaborations and for the community to be benefitted, 

it was recommended that there is a need to establish a deeper understanding 

of IEC and strengthen the Bureau. 

The conference, acknowledging health promotion as a key component of primary 

health care and in line with Ottawa and Bangkok Charter, recommended, to 

strengthen and rename ICB as Health Promotion Division. 

SUMMARY REPORTS ON NUTRITION STUDIES- 

Mrs. Ugyen Zangmo, PO, DoPH 

The Program Officer appraised the forum on the nutritional status in the country. 

It was reported that stunting is still a major issue despite having lots of improvement 

in the nutritional aspects. While the issue of one out of every three children 

being stunted was alarming concerns were also raised on the need to report children 

being overweight and the need to develop baseline as NCD was on rise. 

It was submitted that Anemia is still a major problem despite having a good supply 

of iron folic tablets and reduction in worm infestation. In this line, the forum 

agreed on the need to revisit the dietary habits of the Bhutanese population. 

The participants also submitted to the forum whether the program could explore 

possibility of supporting with formula feed, as it is being done for the HIV infected 

mothers, for children orphaned due to maternal death. 

The forum discussed on issues pertaining to exclusive breastfeeding vs. the rise 

in bottle feeding. Considering that almost one out of 10 children are being bottle 

-27-


fed, the need to stress on exclusive breastfeeding was highlighted. In this line, 

the forum was of the view that maternal leave being restricted to 3 months only 

could attribute to rise in bottle feeding. 

The conference, recognizing - nutrition as an important component for early 

child hood development, recommended the following: 

a. To conduct a study on anemia prevalence and to explore the possibility for 

iron fortification in food; 

b. To conduct a study on breastfeeding among the HIV infected mothers; and, 

c. To promote breastfeeding norms in line with the policy of exclusive 

breastfeeding. 

MMR & MATERNAL AND NEONATAL DEATH INVESTIGATION- 

Mr. Sonam Wangdi, PO, DoPH 

The Program Officer informed the forum that the Reproductive Health Program 

had been recently reviewed identifying gaps and challenges towards achieving 

the major goals and targets. 

The forum deliberated on the following issues: 

• Quality of Antenatal (ANC) and Postnatal (PNC) care 

• Underutilization of BHUs for delivery 

• Under reporting of maternal and neonatal deaths 

• High incidence of cervical cancer 

• Non- functionality of District maternal and Neonatal Death Review Committees 

• Wage compensation for permanent family planning methods 

Additional issues on women not being aware on the five danger signs of pregnancy 

including the health professionals and health centers being over under 

burdened due to ANC were raised. The forum noted that the training on five 

danger signs needs to be carried out on regular basis as new health professionals 

join the health system each year. 

The participants were urged to analyze and understand the problem concerning 

their own district which could done through segregating the district specific data 

from the available overall data and thereby develop strategic plans to address the 

major issues. 

-28-


Submissions were also made on the need to rotate HAs in the district hospital 

wards to conduct delivery so that they acquire the skills to conduct delivery 

once they are placed to BHU. Concerns were also raised on the need to address 

adolescent and male reproductive health issues such as infertility as RH issue in 

addition to the MMR, Neonatal Mortality, un-wanted pregnancy and abortions, 

The conference, acknowledging the importance of reproductive health and further 

considering the key issues identified during the RH program review, recommended: 

a. The need to consider male reproductive issues such as infertility; 

b. To collaborate with the district health office towards furthering the mother and 

child health through incorporation of new components; 

c. The district maternal and neonatal death review committee (DMNDRC) to be 

reinforced and ensure timely submission of complete report; 

d. To revive and provide competency based training for EmONC to the new doctors 

and nurses; and, 

e. To study family planning practices and strengthen adolescent sexual reproductive 

health and to waive off the wage compensation for permanent family planning 

methods. 

COMMITTEE B- Chaired by Dr. Ugen Dophu, Director, DoPH 

HEALTH INFRASTRUCTURE STANDARDIZATION – 

Mr. SB Gurung, Executive Engineer, HIDD 

Mr. S.B Gurung highlighted on the mandates of the Health Infrastructure Development 

Division (HIDD) and the Dzongkhag Engineering Cells. The status of 

three prioritized GOI funded projects of the 10 th FYP viz. construction of 150-bedded 

Regional Referral Hospital in Gelephu, Public Health Laboratory Building 

in Thimphu, and 50 bedded hospital in Samtse were apprised to the forum. Similarly, 

other projects funded by the RGoB for construction of various health infrastructures 

were also apprised. Inadequate budget allocation or financing was 

stated as major constraint for health infrastructure development. The presentation 

also addressed on the implementation status and costing aspects of ORC 

constructions. Geographic locations, demographic dynamics and other social 

factors have been observed as some of the pertinent challenges in implementing 

pre-defined design criteria and typology for construction of BHUs. Contempo- 

-29-


rary costing for both BHU I and BHU II constructions in different regions of the 

country were also tabulated and stated. 

The forum was informed on the availability of guidelines on construction of 

BHUs with seismic measures. 

Following the presentation, the forum deliberated on various technicalities and 

designs of health infrastructures. The forum apprised that the stores in the BHUs 

are small and are inconvenient to fit in the drug and nondrug utilities supplied to 

the BHUs. The forum proposed that the designs for heating and cooling systems 

for the staff quarters should be done by considering climatic factors. 

The forum raised that the design for the outreach clinics should incorporate appropriate 

toilet facilities. The forum also raised that some of the outreach clinics 

are being utilized for purposes other than healthcare viz, extended classrooms by 

the education sector, storage room for farm road construction etc... 

The forum commented that the future designs for the hospitals should provide 

provisions for the HHC and EMT to be stationed. The forum also proposed for a 

disabled friendly BHU design with a designated site for infectious solid and liquid 

waste disposal. The forum raised that the designers at HIDD should device a 

way for the delivery vans to access the stores in a convenient manner. 

The forum raised that air conditioning system should be installed in the labs and 

OTs in order to protect the equipments from damages due to heat. The forum 

raised that appropriate lightening arrestors and earthing facilities should be 

installed in the health centers. The forum also proposed that three phase power 

supply systems should be applied to all the health centers. 

The conference noted that the health infrastructure expansion is happening rapidly 

without taking into consideration the capacity to fulfill human resource 

needs. Further, the conference discussed on the need to take into account new 

issues like rural-urban migration, road accessibility and mobile coverage for infrastructure 

planning. Therefore, in view of these factors, the conference recommended 

the following: 

a. HIDD to review and revise the BHU designs to make it more customized and user 

friendly in consultation with relevant stakeholders from the districts; and, 

b. To review the existing health infrastructure in the context of decentralization 

policy and come up with criteria for new health infrastructure for the 11th FYP. 

-30-


STREAMLINING DRUG PROCUREMENT AND MEDICAL SUPPLIES – 

Mr. Tandin, Acting CPO, DVED 

Acting CPO, Drugs Vaccines and Equipment Division (DVED) outlined some of 

the major challenges that DVED is currently undergoing with the recent procurement 

flaws. He stated that their roles and responsibilities have been restructured 

in a view to strengthen the organizational tasks. Routine investigations by the 

ACC have been stated as major hindrance in normal functioning of the division 

with an interim Head. The overview of Procurement processes was detailed out 

to the forum. He informed the forum for the importance of institutionalizing field 

monitoring and supervisions on medical supplies. 

The forum deliberated on strengthening coordination between Essential Drug 

Programme (EDP) and DVED in assuring proper check and balances on the procurement 

of medical items. It was also informed of need to review and reinforce 

training needs for Health Assistants on the supply chain management and quantification 

management for DHOs. 

It has also been pointed out on the need to revisit and reinforce DHOs decisions 

on prudent quantification of drugs and non-drugs requirements. 

The forum raised that the Essential Drug Programme has failed to deliver 

its mandates due to the inability to retain personnel trained on EDP. The 

forum also raised that a training component on supply chain management 

should be incorporated in the HA’s curriculum of RIHS. It was informed 

that a Health Assistant and a nurse will be trained on store management 

from each BHU and refresher course will be conducted for the trained ones. 

The forum proposed that the distribution of the traditional medicine will be 

soon mainstreamed into the DVED’s general distribution system. 

The conference, recognized the importance of judicious use of drugs and nondrugs 

to save cost and avoid wastage, and thus recommended the following: 

a. The internal mobilization of drugs and non-drugs items to be sustained 

and practiced; 

b. The supply chain management and quantification trainings to be conducted for 

new HAs; 

c. Explore possibility of providing name, specifications and use of equipments with 

pictures for appropriate indenting; 

d. Indenting formula to be made uniform by DVED; 

-31-


e. Quality assurance to be assured by checking the accessories as per specifications; 

f. Additional requests for drugs and non-drug items to be done for reasonable 

quantities and with proper justification; and 

g. Medical supplies for projects to be made as per the MoUs signed between MoH 

and concerned projects; 

INVENTORY AND MAINTENANCE OF MEDICAL EQUIPMENTS – 

Mr. Tshering Dorji, Head- BES, DMS 

Mr. Tshering Dorji, Chief Engineer, BES made a presentation on the inventory 

and maintenance of medical equipments and further highlighted on critical issues 

regarding inventory and maintenance. He informed the forum that the BES 

has been upgraded to a division through the directive provided by the cabinet. 

He apprised the forum that the division has adopted the equipment log book system. 

Further, he also raised that the current system of purchasing the equipments 

with the lowest rates should be reviewed as it leads to the mismatch between the 

brand and specifications of the existing machines and desired accessories. 

Following the presentation, the forum discussed on a series of issues related to 

the medical equipments. 

The conference, realizing the need to make the medical equipments functional at 

all times and to ensure the availability of right equipments at the right facilities 

reinforced that: 

a. The log book introduced in 2009 should be maintained and reported as per the 

guideline (to be developed); 

b. The medical equipment maintenance should be addressed based on the 

assessment of urgency and needs; 

c. To carry out regular preventive maintenance; and, 

d. The Bio Medical Engineering Service should install and train the health 

personnel on installation and use of medical equipments. 

-32-


STRENGTHENING MONITORING AND EVALUATION SYSTEM- 

Mr. Rinchen Namgyal, Dy. CPO, DMS 

Mr. Rinchen Namgyal, DMS, apprised the forum on the objective, relevance 

and importance of the supervision checklist. He also briefed the forum that the 

utilization of supervision checklist has been reviewed and the findings of the 

review were presented to the forum. 

The forum raised their views on the specific components of the check list such 

as the nature of the interviews, sources for data, questions in the checklist on 

the infection control measures etc... The Chair agreed that the feedback on the 

checklist was valid and that a meeting involving the relevant stakeholders should 

be convened to fine tune the checklist. The forum raised queries as to how the 

analysis of the checklist and the follow up on the findings of the analysis are 

carried out. The forum proposed that a response titled ‘don’t know’ to be added 

in the checklist. 

The forum proposed that the job responsibilities of the health professionals 

should be fixed as per the RCSC, PCS system in order to strengthen reporting 

and supervising. 

The conference, accepting the need to supervise and monitor the quality of the 

programs and activities at the various health facilities, recommended that the 

supervision checklist which has been developed by DMS should be reviewed by 

organizing a consultative meeting amongst relevant stakeholders. 

INTEGRATION OF TELEMEDICINE WITH HHC- 

Mrs. Gaki Tshering, Head- ICT 

The Head of ICT, Mrs. Gaki, briefed the forum on the integration of telemedicine 

consultation with HHC. The main purpose of contention was to find out 

the reasons for not being able to use and sustain rural telemedicine system in the 

districts. 

Further, suggestions and feedbacks were sought from the forum to improve use 

of rural telemedicine and to explore feasibility of integrating with HHC. 

The CEO for HHC suggested that a study must be carried out before integrating 

telemedicine with HHC involving relevant stakeholders. The forum raised that 

the software used for telemedicine is not user-friendly and highlighted the need 

-33-


to give more hands-on training to the DHOs. The forum pointed out that the initiation 

of SAARC telemedicine project (the time required for video consultations) 

has hindered the use of rural telemedicine software in JDWNRH. 

The Chair commented that the main bottleneck for telemedicine is the attitude 

of the medical professionals, in particular, reluctance in accepting the change in 

systems. 

The conference, acknowledging the shortage of specialist in the country and the 

role that the telemedicine can play in curbing this shortage, recommended: 

• To conduct a feasibility study for integrating telemedicine with the Health Help 

Center; 

• Telemedicine focal to come up with measures to change the attitude of the medical 

professionals, particularly, the reluctance to accept the change in system; 

• To revisit the sustainability of telemedicine projects; 

• To ensure the installation of user friendly application/software and provide more 

hands-on training to the users; and, 

• Explore the use of Mobile technology. 

-34-

DAY 3 

PLENARY SESSION 

NOVEMBER 9 2011 

-35-


PLENARY SESSIONS 

The plenary sessions of the 

conference was chaired by 

the Director General, DMS 

and co-chaired by the Director, 

DoPH. 

REPORT ON CURRENT STATUS OF POLIOMYELITIS ERADICATION – 

Mr. Phub Rinchen, National Polio Commission 

Mr. Phub Rinchen briefly outlined on Terms of Reference for the National Certification 

Commission for Polio Eradication (NCCPE) and highlighted on the status 

of polio cases in the region. Further, he deliberated on evidence based routine 

OPV immunization coverage, monitoring of AFP status and effective implementation 

of zero reporting system. Further, general findings of polio surveillances 

were also apprised to the forum. 

Following recommendations were submitted to the forum for endorsement: 

• Eastern districts to send stool samples directly to DVED, instead of routing 

through Mongar Regional Referral Hospital, for earliest delivery of 

the sample 

• To conduct refresher trainings for health workers including briefing for 

new and expatriate doctors 

• To release the TA/DA of the Surveillance Officers on time, as a motivation 

factor 

• To provide immunization of children of day albourers from across theborder 

(Assam and West Bengal) as per the recommendation of WHO 

Expert 

• To improve immunization strategy for those going on pilgrimages to 

Godhgaya, especially polio vaccine 

• Surveillance Officers to conduct active surveillances 

• To conduct workshop once a year for all the Survellince Officers together 

with the NCCPE and necessary budget to be allocated for the workshop. 

-37-


Concerns were raised on the need to review surveillance reports as inconsistency 

in the number of days undertaken for surveillance visits were noticed. However, 

there was also a concern for cross checking of OPD, lab and MCH on zero reporting. 

The forum deliberated on the need to strengthen screening mechanism for pilgrims 

travelling to India through porous border by ensuring at least two drops of 

polio vaccines being provided to the pilgrimages. The forum also raised concerns 

over the immunization of day laborers’ children in the bordering towns and further 

directives were sought on the matter. The forum directed to strengthen advocacy 

and IECs for pilgrimage through various mass media. 

Concerns were also raised on the large turnovers of existing trained EPI Technicians 

and submitted the need to train new EPI Technicians to ensure adequate 

replacement of EPI Technicians. The forum urged all health workers to strive 

towards for achieving polio eradication certification from the WHO. 

In order to intensify efforts towards eradication of Polio, the following were 

recommended: 

a. Maintain uniform standard operating procedures for AFP surveillance in all 

districts; 

b. Review AFP surveillance guidelines and ensure optimum enforcement; 

c. To fill up the vacant post of the two Polio Commissioners; and, 

d. Strengthen coordination in the border towns for eradication of polio. 

NEW VACCINES AND SCHEDULES (YEAR OF INTENSIFICATION FOR 

IMMUNIZATION) – 

Mr. Tandin Dorji, CPO, CDD 

The Chief Program Officer, CCD informed the forum on the importance of intensifying 

of routine immunization in 2012 which was declared during the High 

Level Health Ministers Meeting on “increasing and sustaining immunization 

coverage in South East Asia, held on 2 nd August 2011, in New Delhi, India. 

The forum was informed that though the national immunization coverage has 

been achieved as 90%; as recommended by WHO, there is a need to accelerate to 

achieve the target of 80% coverage in the districts. Therefore the need to address 

-38-


significant variations of immunization coverage in the districts was emphasized. 

The major findings and challenges of immunization such as EPI/Immunization 

delivery and VPD Surveillances were outlined for the discussions. Overall visions 

and goals of intensifying routine immunization were also outlined with 

findings of immunization trend analysis. 

It was observed that the Haa and Sarpang districts have low achievement of immunization 

coverage, which is below 80% of the national standard. He also informed 

the forum of the denominator problem in calculation of immunization 

coverage and directives were sought for the use of NSB or the administrative 

data for the analysis. 

New immunization coverage target (95% national and 90% at the district levels) 

was proposed to the forum for deliberations and adoption. He also highlighted 

on the following areas for the improvement: 

• Programme review 

• Improve reporting 

• Improve HPV coverage 

• Strengthen surveillances (AFP, AEFI, AES, MR, MNT) 

• Monitoring and supervision at the district level 

Hon’ble Lyonpo informed that Gates and Melinda foundation has committed 

$10 billion as evidently published in report of G8 Summit meeting held in Geneva 

and the primary focus was on mother and child health. Further, the forum 

was informed that UN Secretary General has earmarked $ 60 billion for MCH 

development. Therefore, Hon’ble Lyonpo instructed the forum to come out with 

good proposals pertinent to immunization and vaccines. 

Realizing that the vaccination is one of the best ways in preventing child mortality, 

the UNICEF has fully committed to support resource mobilization for vaccines 

and immunization activities. Need to scale up TT/TD vaccination for child 

was also raised and to explore devising multi-sectoral synergies for capturing 

unreached population of young girls for effective HPV vaccination 

The forum also deliberated to explore installation of cold chain system in remote 

places like Lunana and other higher altitude regions. Concerns were raised on 

capturing the nomadic and mobile population for effective and complete vaccination. 

Intensifying missed population of immunization with appropriate methods 

of investigation during the field visits was considered crucial. 

-39-


In order to enhance immunization coverage, the forum emphasized on intensification 

of immunization programme with the following recommendations: 

a. Ensure adequate resources and improve coordination for implementation and 

monitoring of immunization activities at both the central and Dzongkhag 

level; 

b. Materialize appropriate application of ICT for effective monitoring of 

immunization activities including tracing of missing population for 

vaccination; 

c. Strengthen collaboration within relevant stakeholders in the districts by 

improving community networks; and, 

d. Strive to achieve 100% immunization coverage. 

COMMUNITY BASED MEDICAL CARE FOR THE ELDERLY IN TOSA 

TOWN, JAPAN – 

Professor Kiyohito Okumiya & Professor Ryota Sakamoto 

The forum was made aware of the eminent ageing population and related medical 

care associated with ageing. The presention highlighted on a study carried 

out in Tosa, Japan and a similar pilot study conducted at Khaling, Trashigang. 

The study findings showed that the community based medical care is an efficient 

method in addressing elderly health care in the community. 

The professor highlighted that compassionate care with a humanistic approach is 

more effective in curing the elderly chronic health problems. 

Acknowledging the impact of pilot project on Elderly Care which was instituted 

at Khaling BHU, the forum recommended exploring the possibility of gradually 

rolling over the project throughout the country. It was also recommended to integrate 

Elderly Care into the Primary Health Care system during the 11th FYP. 

-40-


PUBLIC HEALTH ENGINEERING DIVISION- 

Mr. Ugyen Rinzin, PHED 

The Executive Engineer appraised the forum on the status of the progress made 

on the water and sanitation in relation to the national and global goals and targets. 

The forum was also informed on the outcome of an independent Rural Sanitation 

and Hygiene Programme (RSAHP) evaluation. The division proposed the 

following way forward: 

• Raise the priority both at central and district level on sanitation; 

• Place greater focus on sanitation, not as a sub-set of water; 

• Facilitate active engagement of other sector and developmental partnersto 

provide holistic support to sanitation; 

• Change the way sanitation is monitored beyond coverage alone 

The forum noting the need to strengthen accessibility to improved sanitation 

and hygiene endorsed the way forward proposed by the division. In addition, the 

forum strongly recommended the following: 

a. Incorporate sanitation and hygiene as a priority agenda during the 11 th 

FYP both at Central and Dzongkhag level and to consider sanitation as a 

separate component and not as a sub set of water; and 

b. Dzongkhags to collect data (RWSS Coverage and Functionality) based on 

the Geog based Rural Water Supply Scheme MIS and report to the division 

by December 2011. 

HEALTH STAFF WELFARE SCHEME- 

Dr. Ugen Dophu, Director, DoPH 

The Director, DOPH in his capacity as the Fund Manager informed the forum on 

the objectives, membership, benefit and fund position till date. Issues pertaining 

to receipt of incomplete application forms for membership, benefits and irregularity 

in repayment of the monthly loan installments were highlighted. The 

forum was also informed on the non-availability of records for the HSWS funds 

collected till June 2008. 

The forum deliberated on the issues related to the loan and semso ceiling and the 

lengthy process taken to receive the benefits particularly for the district health 

staff. Considering this, suggestions were made on possibility of decentralizing 

fund management to the dzongkhags. 

-41-


Noting the issues on inadequacy of Loan and Semso and delay in receipt of benefits 

and payments, the forum recommended the following: 

a. The fund manager to discuss with the board on the following: 

• Decentralization of fund management; 

• Revision of the loan and semso amount 

b. HSWS office to share the loan repayment statement annually with Dzongkhag 

authorities; and, 

c. Use internet banking facilities to facilitate timely disbursements of loans 

and benefits. 

RECOMMENDATIONS OF 9 TH ANNUAL TRADITIONAL MEDICINE 

CONFERENCE – Drungtsho Tshering Tashi 

The Superintendent, NTMH presented the recommendations of the 9 th Annual 

Traditional Medicine Conference. The six recommendations presented were endorsed 

by the forum. 

In view of the concerns raised on employment opportunities for the NITM graduates, 

Hon’ble Lyonpo informed the forum that DHI is working on the Wellness 

Centre Project which will create opportunities to employ graduates from NITM. 

The forum was also informed that, in line with RCSC norms, a division will be 

established within the Ministry which would cater to the policy issues of traditional 

medicine. 

In addition, the forum recommended the following: 

a. To discuss the issues pertaining to change in nomenclature for Drungtshos and 

sMenpas during the next annual Traditional Medicine Conference; 

b. To institute a mechanism to attach new medical officers with indigenous 

hospital and Drungtshos with JDWNRH for a period of 15 days to enhance 

collaboration between the two system; and, 

c. Design appropriate curriculum so that the graduates of the ITMS become 

employable in the wellness centers. 

-42-


RECOMMENDATION OF 2 ND MEDICAL CONFERENCE- 

Dr. Drupthob Sonam, Medical Superintendent 

The Medical Superintendent, JDWNRH presented the 18 recommendations endorsed 

during the 2 nd Medical Conference which was held from 3-5 October 2011. 

The conference directed to prioritize (around 8-10) recommendations of the 2 nd Medical 

Conference which is considered endorsed and hand it over to the secretariat. 

Closing session 

The Hon’ble Minister was apprised on the recommendations generated over the 

past three days by the CPO, PPD. After incorporation of comments received from 

Hon’ble Minister the recommendations were endorsed. 

-43- 

Following the endorsement, 

the reflections on 

the conference was provided 

by Dr. Kinley Penjore, 

DMO, Zhemgang 

and Mr. Yeshey, DHO, 

Chukha. 

In his closing remark, 

Hon’ble Lyonpo thanked 

the participants for their 

active participation; he 

thanked the chairman 

and the co-chair for their 

tireless directions and effortful 

chairmanship. Lyonpo thanked the organizing team led by Dr. Lungten 

Z. Wangchuk and the team of rapporteurs who worked diligently to produce the 

professionally drafted 21 recommendations. He applauded and appreciated the 

idea of Mr. Kado Zangpo to adopt and execute for the first time, a dual committee 

system for the first Biennial Health Conference. 

Hon’ble Lyonpo urged the health professionals working in the field to work tirelessly 

in delivering healthcare to the people who require it. The session closed 

with a vote of thanks delivered by Dr. Tapas Gurung, the Medical Superintendent 

of MRRH.

RECOMMENDATIONS 

-45-


1 st Biennial Health Conference 

7-9 November 2011 

Mongar 

Sl # 

Recommendations 

Responsible 

Unit(s) 

Department of Public Health 

The conference recommended integrating PMTCT with 

MNCH and improve on the VCT in every MCH session. 

The conference acknowledged the critical role of MSTFs 

particularly in the areas of inter-sectoral collaboration. 

1. 

It was recognized that MSTF should be revitalized and 

expand its role to involve other public health issues. 

Meanwhile, health sector would continue to take the lead 

role in conducting MSTF activities (HIV/AIDS and RH) 

HIV/AIDS & 

RH Program, 

DoPH 

2. 

3. 

4. 

Noting the rising cancer incidence in the country and 

poor documentation, the conference emphasized on 

the development of a cancer registry by LSRD program 

at JDWNRH and to explore the possibility of starting 

population based cancer registry system. 

The conference, acknowledging health promotion as 

a key component of primary health cares and in line 

with Ottawa and Bangkok Charter, recommended, 

to strengthen and rename ICB as Health Promotion 

Division. 

The conference, recognizing nutrition as an important 

component for early child hood development, recommended 

the following: 

a. To conduct a study on anemia prevalence and to 

actively explore the possibility for iron fortification 

in food; 

b. To conduct a study on breastfeeding among the 

HIV infected mothers; and, 

c. To aggressively promote breastfeeding norms in 

line with the policy of exclusive breastfeeding. 

-47- 

LSRD, DoPH 

and DoMS 

ICB, DoPH 

Nutrition 

program, 

DoPH


Sl # 

5. 

6. 


The conference, acknowledging the importance of 

reproductive health and further considering the key 

issues identified during the RH program review, 

recommended: 

a. The need to consider male reproductive issues 

such as infertility; 

b. To collaborate with the district health office towards 

furthering the mother and child health through 

incorporation of new components; 

c. The district maternal and neonatal death review 

committee (DMNDRC) to be reinforced and ensure 

timely submission of complete report; 

d. To revive and provide competency based training 

for EmONC to the new doctors and nurses; and, 

e. To study family planning practices and strengthen 

adolescent sexual reproductive health and to waive 

off the wage compensation for permanent family 

planning methods. 

The conference noting the need to strengthen 

accessibility to improved sanitation and hygiene 

endorsed the way forward proposed by the division. 

In addition, the conference strongly recommended the 

following: 

a. Incorporate sanitation and hygiene as a priority 

agenda in the 11th FYP both at the Central and 

Dzongkhag level and to consider sanitation as a 

separate component (not as a sub-set of water); 

and, 

b. Dzongkhags to collect data (RWSS Coverage and 

Functionality) based on the Geog based Rural Water 

Supply Scheme MIS and report to the division by 

December 2011. 

-48- 

Responsible 

Unit(s) 

RH program, 

DoPH 

PHED, DoPH


Sl # 


Responsible 

Unit(s) 

7. 

In order to intensify efforts towards eradication of Polio, 

the following were recommended : 

a. Maintain uniform standard operating procedures 

for AFP surveillance in all districts; 

b. Review AFP surveillance guidelines and ensure 

optimum enforcement; 

c. To fill up the vacant post of the two Polio 

Commissioners; and, 

a. Strengthen coordination in the border towns for 

eradication of polio. 

EPI Program, 

DoPH 

8. 

In order to enhance immunization coverage, the forum 

emphasized on intensification of immunization programme 

with the following recommendations: 

a. Ensure adequate resources and improve 

coordination for implementation and monitoring 

of immunization activities at both the central and 

Dzongkhag level; 

b. Materialize appropriate application of ICT for 

effective monitoring of immunization activities 

including tracing of missing population for 

vaccination; 

c. Strengthen collaboration within relevant 

stakeholders in the districts by improving 

community networks; and, 

d. Strive to achieve 100% immunization coverage. 

EPI Program, 

DoPH 

-49-


Sl # 

Department of Medical Services 


Responsible 

Unit(s) 

9. 

Acknowledging the impact of pilot project on Elderly 

Care which was instituted at Khaling BHU, the forum 

recommended to explore the possibility of gradually 

expanding the project through out the country. It was 

also recommended to integrate Elderly Care into the 

Primary Health Care system during the 11 th FYP. 

DoMS 

10. 

The conference noted that the health infrastructure 

expansion is happening rapidly without taking into 

consideration the capacity to fulfill human resource 

requirements. Further, the conference discussed on the 

need to take into account new issues like rural-urban 

migration, road accessibility and mobile coverage for 

infrastructure planning. Therefore, in view of these 

factors, the conference recommended the following: 

a. HIDD to review the BHU designs to make it more 

customized and user friendly in consultation with 

relevant stakeholders from the districts; and, 

b. To review the existing health infrastructure in the 

context of decentralization policy, consolidation 

Vs. expansion and come up with criteria for new 

health infrastructure for the 11th FYP. 

HIDD, DoMS 

and PPD 

-50-


Sl # 

11. 

12. 


The conference, recognized the importance of judicious 

use of drugs and non-drugs to save cost and avoid 

wastage, and thus recommended the following: 

a. The internal mobilization of drugs and non-drugs 

items to be sustained and practiced; 

b. The supply chain management and quantification 

trainings to be conducted for new HAs; 

c. Explore possibility of providing name, 

specifications and use of equipments with pictures 

for appropriate indenting; 

d. Indenting formula to be made uniform by DVED; 

e. Quality assurance to be assured by checking the 

accessories of non-drugs as per specifications; 

f. Additional requests for drugs and non-drug items 

to be done for reasonable quantities and with 

proper justification; and 

g. Medical supplies for projects to be made as per 

the MoUs signed between MoH and concerned 

projects. 

The conference, realizing the need to make the medical 

equipments functional at all times and to ensure the 

availability of right equipments at the right facilities, 

reinforced that: 

e. The log book introduced in 2009 should be 

maintained and reported as per the guideline (to 

be developed); 

f. The medical equipment maintenance should be 

addressed based on the assessment of urgency and 

needs; 

g. To carry out regular preventive maintenance; and, 

h. The Bio Medical Engineering Service should install 

and train the health personnel on installation and 

use of medical equipments. -51- 

Responsible 

Unit(s) 

DVED, 

DoMS 

BES, DoMS


Sl # 

13. 


The conference, acknowledging the shortage of 

specialist in the country and the role that telemedicine 

can play in addressing this shortage, recommended: 

a. To conduct a feasibility study for integrating 

telemedicine with the Health Help Center; 

b. Telemedicine focal point to come up with 

measures to change the attitude of the 

medical professionals, particularly, the 

reluctance to accept the change in system; 

c. To revisit the sustainability of telemedicine 

projects; 

d. To ensure the installation of user friendly 

application/software and provide more 

hands-on training to the users; and, 

e. Explore the use of Mobile technology. 

Responsible 

Unit(s) 

Telemedicine 

Program, 

DoMS 

Secretariat, JDWNRH and NTMH 

The conference raised issues on inadequacy of Loan and 

Semso and delay in receipt of benefits and payments. 

The forum recommended the following: 

a. The fund manager to discuss with the board on the 

following: 

14. 

i. Decentralization of fund management; 

ii. Revision of the loan and semso amount 

b. HSWS office to share the loan repayment statement 

annually with Dzongkhag authorities; and, 

c. Use internet banking facilities to facilitate timely 

disbursements of loans and benefits. 

HSWS 

-52-


Sl # 


Responsible 

Unit(s) 

15. 

The conference endorsed all the recommendations of 

the 9 th Traditional Medicine conference. Further, the 

following were recommended: 

a. To discuss the issues pertaining to change in 

nomenclature for Drungtshos and sMenpas during 

the next annual Traditional Medicine Conference; 

b. To institute a mechanism to attach new medical 

officers with indigenous hospital and Drungtshos 

with JDWNRH for a period of 15 days to enhance 

collaboration between the two system; and, 

c. Design appropriate curriculum so that the graduate 

of the ITMS become employable in the wellness 

centers 

NTMH 

16. 

The conference directed to prioritize eight to ten 

recommendations of the 2 nd medical conference which is 

considered endorsed and hand it over to the secretariat. 

JDWNRH 

17. 

The framework for 11 th FYP was presented and discussed 

in detail. and the conference recommended to: 

a. Broaden the key result area in addition to the ones 

identified by GNHC; and, 

b. Explore ways of getting committed budget 

allocation for the 11 th FYP to do realistic planning 

which will also enhance performance and clinical 

auditing. 

PPD 

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Sl # 


Responsible 

Unit(s) 

18. 

Recognizing the importance of surveillance system, 

disease control and rapid response to outbreak, the 

conference recommended to device mechanism to 

oversee the adherence to the existing surveillance manual 

by all health workers. To further enhance the system, the 

research unit will need to train relevant health workers 

in data collection and analysis. 

Research 

Unit/PHL 

19. 

For better functioning of health system, the conference 

emphasized to improve data quality and completeness 

at all levels including hospitals. Hence, conference 

reiterated to fill the approved vacant post of Medical 

Record Officers and Medical Record Technicians in major 

hospitals immediately and to explore the possibility of 

recruiting Medical Record Technicians in all hospitals. 

The conference also recommended to train health 

workers on ICD 10 coding and expedite the use of HIS 

as early as possible. 

HRD/HMIS 

-54-


Sl # 


Responsible 

Unit(s) 

20. 

Recognizing HR as the key driver for health service 

delivery, the conference recommended strengthening 

the HR system in terms of rational deployment and fair 

and transparent HR development. The implementation 

of PCS and its impact were discussed in detail, and 

following were recommended strongly: 

a. Review the entry grades for professionals with 

MBBS and specialist qualification; 

b. Review and develop a mechanism of providing oncampus 

accommodation for health workers in order 

to provide uninterrupted emergency services and 

for ensuring uniformity or provide compensation. 

This is also in line with the Accelerating Bhutan’s 

Socio-economic Development (ABSD) initiatives; 

c. Explore provision of uniform/dress allowances for 

all clinical workers; and, 

d. Review and restructure the office of the District 

Health Officer in consideration of, among others, the 

population and geographic size of the Dzongkhag. 

HRD & 

DoMS 

21. 

The conference, accepting the need to supervise and 

monitor the quality of the programs and activities at 

the various health facilities, recommended that the 

supervision checklist which has been developed through 

HMIS should be reviewed by organizing a consultative 

meeting amongst relevant stakeholders. 

HMIS 

-55-

ANNEXURE 

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Annexure 1- INAUGURAL ADDRESS by Hon’ble Health Minister, Lyonpo 

Zangley Dukpa, 

Honourable Members of Parliament, Dasho Dzongdag, Dasho Drangpon, Lam Neten, 

Development Partners, Distinguished Guests, my Colleagues, Ladies and Gentlemen 

1. You will agree with me that we are happy to convene our first biennial health 

conference in the dzongkhag town of Mongar. All Annual Health Conferences 

except the one in Gelegphu in 2007 in the past were convened in Thimphu. In its 

wisdom, the present Government issued the directives that all ministries and agencies 

should have biennial conferences instead of annual conferences to curb and contain 

expenditures and also make such conferences more effective and results-oriented. 

2. Away from Thimphu, I hope we will be able to reflect upon and review policies 

and programmes in the context of progress, problems and prospects concerning 

Ministry of Health in particular and the country in general. The Mongar town, which 

is growing fairly fast compared to other dzongkhag towns in the eastern region, does 

provide right environment for productive and meaningful conferences such as the 

one we have now. 

3. In my statement, I will briefly highlight the achievements made in health sector, 

challenges facing the ministry and way forward and my avid appeal to all medical 

and health professionals. 

4. I am not trained as a health worker. So, I consider myself a lucky person to get the 

wonderful opportunity to work in the ministry of health. We all know that Health 

is a cause for either happiness or unhappiness for individuals as well as societies. 

Mindful of this axiom and also guided by the philosophy of gross national happiness, 

the Royal Government of Bhutan under the enlightened leadership of our Kings 

has founded and developed our health care system focusing on the primary health 

care and is provided free of cost on the basis of equity and justice. We now have 

one of best primary healthcare systems in the world. We have achieved universal 

health coverage; we were given the GAVI Award in 2010 for the best performance in 

immunization programme covering over 95%; life expectancy is now 66 years plus; 

maternal and under-five morbidity and mortality decreased significantly in the past 

few decades; infant mortality per 1000 live births decreased from 203 in 1960 to 40.1 

in 2005. We have already achieved two health related MDGs and are well on track 

to achieving the rest. According to estimates developed by WHO, UNICEF, UNFPA 

and World Bank, Bhutan was ranked among the top four best performing countries 

in the reduction of maternal mortality by 40% or more between 1990-2008. In terms 

of physical infrastructure, Bhutan today boasts of 31 hospitals, 14 BHU-I, 166 BHU- 

II, 38 Indigenous Units, and 518 ORCs. All these achievements were made possible 

under the farsighted leadership of our beloved Monarchs, and of course, through the 

enduring efforts of our health workers past and present, national partners, and with 

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generous assistance of our development partners. This is truly a big achievement, 

especially in the light of how countries including the developed ones across the world 

are currently struggling to arrest and address the ever widening gaps in health care 

inequities compounded by ever increasing healthcare expenditure. 

5. Having shared with you the achievements over the past many years, you also 

deserve to know the major achievements made in the last three years. 

• The comprehensive National Health Policy was launched in June 2011 with 

the approval of Lhengye Zhungtshog. I am sure, by now, you will have read 

this important document, which will guide us in our day-to-day work. 

• We are the first Ministry to venture into working on the National Health 

Accounts and National Health Expenditures, intended to track resources and 

results. 

• Our Ministry is proud to have the comprehensive Human Resource Master 

Plan launched recently. All trainings both short and long terms, recruitment 

and deployment of medical and health professionals will be done as per this 

master plan. In the process, it is intended to promote transparency, equity 

and justice. 

• The Ministry has in place the National Strategy Framework for prevention and 

control of NCD and the National steering Committee formed to implement 

this strategic framework. 

• In order to address the acute shortage of nurses, we have implemented the 

Accelerating Nursing Training Programme in 2008, through which over 200 

nurses were trained in colleges in India and more are being trained. These are 

in addition to those nurses trained in RIHS. This has also created employment 

opportunities for our Class XII students. 

• Recognizing the importance of upgrading qualification of our health workers, 

who are in service, we have introduced the programme of Bachelors in Public 

Health at RIHS. The first batch will soon graduate and resume their duties 

in health centres with enhanced competence. B.Sc Nursing programme both 

for In-Service and Pre-service students will start in January and June 2012 

respectively. 

• Although the progress is slow, we hope to start the MBBS programme next 

year with the establishment of either BIMS or BUMS. The National Assembly 

has passed the Bill in the last session and we hope that NC will discuss and 

pass it in the forth coming Winter Session of the Parliament of Bhutan. 

• About 300 students are currently pursuing MBBS including private students 

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in different countries mainly in India, Sri-Langka, Bangladesh and Thailand. 

Over 35 doctors are presently pursuing Masters or specialized programmes 

in different disciplines in different countries. From 2013 and 2014 onwards, 

20 plus MBBS doctors will graduate every year. Obviously, this will ease 

the problem of shortage of doctors. Due to acute shortage of doctors, the 

Government has decided to give financial support to private medical students 

on the merit basis. 

• Besides recruitment of doctors from Myanmar, volunteer-doctors from 

America and other countries to work in Bhutan under the agreed terms and 

conditions are welcomed. 

• One of the visible and tangible achievements is the procurement and 

distribution of over 73 new ambulances, which are equipped with GPS and 

GIS. 26 more ambulances will arrive in December this year from Japan. 

• A landmark achievement in the history of health care service is the launch 

of Health Help Centre with its three broad functions namely medical triage, 

emergency medical service and public health education/promotion. Provided 

there is mobile network, this Centre aims to enable people, whoever they 

are and wherever they are and any time to access the services of a health 

professional within one hour. This also aims to address the problems of 

inequity and shortage of health professionals. 

• The Ministry of Health signed five chapters under the Accelerating Bhutan’s 

Socio-Economic Development (ABSD), all of which are geared to improve 

the delivery of health services and achieve efficiency to reduce cost including 

waste. We are on track to achieve all aspirations as reflected in the chapters. 

Hospital Management and Administration Transformation is one of the 

initiatives. 

• To decongest the out-patients in the morning and use doctors’ time more 

meaningfully, we have successfully started last year the Special Consultation 

Service in the evening at JDWNRH. While the JDWNRH management has 

done its review, the PPD is in the process of reviewing and evaluating this 

service as required under the directive of the Cabinet. 

• Many countries are envious of our introduction of HPV vaccines in 2010 

(quote what health minister of Assam shared with me). We have also reintroduced 

successfully the pentavalent vaccine this year. 

• In 2008, the Department of Ophthalmology at JDWNRH had done cornea 

transplant coinciding the Coronation Celebration and many new services are 

being introduced to reduce the referral of patients outside the country. 

• We have streamlined the referral and treatment system, especially in Kolkatta. 

Five or six hospitals are empanelled and their performance is reviewed every 

six months. The reform has brought about a big change in the treatment 

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of our patients including the control of cost. According the detailed report 

submitted by the Liaison Officer in Kolkatta, the cost of treating over 500 

patients in 2008-2009 was estimated at over 90 million and the cost of 635 

patients in the subsequent fiscal year was just over 70 million as a result of the 

reform and streamlining of the system. Patients also receive better treatment 

and care. 

• We have streamlined and reformed the procurement of drugs and medical 

equipments and also carried out the administrative reform in the Ministry to 

achieve greater efficiency and cost effectiveness. Three months moratorium 

was adopted for training outside the country for all officers in the Secretariat 

during which all programme officers assessed the impact of training, 

workshops, seminars and conferences. 

• As regards the rural water supply scheme, nationwide survey was done in 

August 2008 and actions taken as per the findings of the survey. Rain water 

harvesting and water pumping technology are being promoted in places 

where water sources are drying up. Provision of safe drinking water to each 

household in rural areas is one of the minimum or priority programmes of 

the Government. 

• In terms of infrastructure development, we have published and distributed 

the standard designs and drawings for health facilities and revised again 

for ORC and BHU sequel to the outcome of MTR making the designs more 

customized for different climatic zones and also more cost effective. 

• Learning lessons from the mistakes made in the designs, drawings and 

construction of 350 bedded Hospital in Thimphu and 150 bedded Hospital 

in Mongar, we have come up with fairly good designs and drawings for 

the Gelegphu referral hospital. We have almost completed the drawings for 

Samtse and Tsirang district hospitals, and PHL in Serbithang following the 

green concept to the extent possible. 

6. As stated already, there are numerous and various accomplishments made in 

addition to the above major ones. For want of time and space, it is difficult for me to 

report on the implementation and achievements of all 166 programmes and activities, 

most of which are funded by WHO, UNICEF, UNFPA and others. 

7. Notwithstanding our huge successes, we continue to be confronted with several 

pressing problems and challenges. The Ministry of Health has been under the 

investigation of ACC and continues to be a constant source of news in all forms of 

media especially on issues related to the procurement of medical supplies. While the 

findings of ACC investigations and its publicity in mass media might have blighted 

the image of our Ministry and may have disheartened many or some of you, we 

must acknowledge that such investigations have identified and exposed systemic 

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flaws in the procurement system thus enabling us to take timely corrective measures. 

8. The Ministry of Health has since accorded top priority to strengthen our procurement 

system into one that is highly effective, transparent, and reduces unnecessary costs 

and delays. 

9. Shortage of some drugs and medical supplies in the past one year or so in the country 

has been another major issue that has captured repeated media attention and outcry 

from people directly or indirectly affected by it. The causes of drug shortage are 

complex. You may refer to my address to the participants in the Second Medical 

Conference, which can be accessed from our health website. With an improved 

procurement system in place, I hope that the problem of drug shortage in the country 

will become the things of the past. Let us not forget that even the most developed 

countries like America are facing the acute shortage of vital drugs as was evident from 

the directives issued recently by the President Obama to FDA and pharmaceutical 

companies. I must urge all of you to play your part by respecting and responsibly 

implementing the system that is now put in place. 

10. We are faced with a growing number of multiple health challenges that are constantly 

threatening our well functioning healthcare system, one of which is financing. The 

Royal Government is committed to providing free basic health care services to all its 

citizens as enshrined in the Constitution. But, the Government is gravely concerned 

about ever increasing healthcare expenditure. According to the recently completed 

National Health Accounts Report, the government spending on health increased 

from Nu.726 million in 2000-2001 to Nu. 1980 million in 2009-2010. This is an increase 

of more than 100% in the past one decade alone. And, the cost of healthcare is going 

to precipitously escalate in the coming years. The sustainability issue will keep 

nagging us. 

11. The term “Double Burden of Disease” may sound like any other fancy technical 

jargon whose importance diminishes over time as a result of overuse. For us, it is a 

matter of grave concern requiring immediate attention. 

12. Despite the persistent progress made in the control of communicable diseases, we 

still struggle with traditional diseases related to water, sanitation and hygiene. 

Further, new cases of TB, HIV, Vector Borne Diseases (even in non-endemic areas), 

and sexually transmitted infections, among others, continue to emerge and burden 

us. As a member of this highly globalized world, we also remain highly vulnerable 

to impending threats of exotic diseases of international origin with severe public 

health consequences. The most worrying thing about communicable diseases is the 

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emergence of a rising number of drug resistance micro-organisms which also has huge 

potential to spread to larger communities from both within and outside the borders. 

As a case in point, if we look at only the cost of medicine of AMR, the treatment of 

one drug resistant tuberculosis per patient increases from approximately Nu. 800 to 

almost 98,000/- according to our records. What will be the life-long treatment cost 

of one HIV patient to the Royal Government who develops resistant to currently 

available ARV drugs? The issue of drug resistance alone, if not addressed urgently, 

could be catastrophic to our publicly financed health system. 

13. In addition to the challenges of communicable diseases, we are now faced with a 

growing burden of chronic non-communicable diseases resulting from avoidable and 

modifiable risk factors such as poor dietary habits, harmful alcohol consumption, 

physical inactivity, and tobacco use, among others. For example, diabetes cases 

increased from 944 in 2005 to 2605 in 2009. According to the records maintained by 

JDWNRH, more than 50% of all in-patient mortality is attributable to NCDs. In the 

past three years, 71% of all referral cases outside of Bhutan were NCD related and 

the Royal Government of Bhutan had spent Nu. 144 million on these referral cases in 

the last one year. In addition to incurring huge cost to our health system, the NCD 

also drives those suffering from it and their family members below the poverty line. 

Thus, our situation of NCDs is alarming especially because Bhutan is known to 

the outside world as a champion of Primary Health Care. We have to think hard 

and start acting such as integrating NCD into primary healthcare. The result of Pilot 

Project in Paro and Bumthang on NCD focusing on diabetes as part of primary health 

care is encouraging and we hope to roll out in other dzongkhags. 

14. While there is the National Steering Committee on NCD aimed at involving all 

stakeholders, we feel that the role of MSTF in dzongkhags could be expanded to 

look into all heath related issues. 

15. Despite some of the challenges I highlighted, I earnestly exude confidence in all 

my colleagues. Those who are present here are the leaders of health and all health 

professionals across the country are well equipped with knowledge, skills and 

professional ethics and values to address the challenges facing the Ministry of Health 

at all levels. 

16. We may have the best of best facilities and infrastructures in the form of buildings 

and equipments. What is the point of having such splendid and fantastic facilities if 

our health professionals are deficient in qualities of human beings? You and I will 

agree that goodness and compassionate attitude of our health workers will make 

a big difference in the lives of patients and in fact, good doctors and good nurses 

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will compensate the shortage of drugs, poor facilities and any other shortfalls and 

deficiencies. How you receive patients at the reception desk and care you provide 

throughout their stay in the hospitals or health centres is critical and crucial to 

gain confidence of our people. If we receive our patients with respect, care and 

compassion, they will feel good. Feeling good is a clear symptom of good health. 

Therefore, I would like to appeal to our health workers to be kind, caring, respectful 

and compassionate, which are termed as humanistic medicines. This humanistic 

medicine, as I said, will compensate shortage of drugs and medical equipments. 

17. As I mentioned earlier, I am not a trained health worker. I consider myself as one 

of key facilitators. I really enjoy working with you all. Our health workers are 

wonderful people, who are committed and dedicated to the raising of standard of 

delivery of health services so that our people lead healthier and happy life. To repeat 

what I said earlier, health is a cause for either happiness or unhappiness. Poor health 

is also a cause for poverty as I already alluded to. It has been continuous policy of 

the Royal Government to address the problem of poverty in the country. Thus, the 

current Government is committed to implement the minimum programmes which 

include construction of roads to connect all Gewog Centres with the exception of few 

Gewogs, provide electricity to all households, RWSS, mobile connectivity, universal 

primary education and so on. We, as health workers, have a big responsibility to 

address the problem of poverty through keeping our people healthy. I earnestly 

appeal to all my friends to be mindful of this responsibility all the time and discharge 

your duties diligently. If you enjoy your work as health workers, you will make 

others enjoy their good health. 

18. I agree that the responsibility of health falls on every individual and an organization 

or institution or a community. But as trained health workers, we have to play a 

lead role in public health education and prevention programmes empowering and 

involving communities. Our Health Assistants in BHUs, I know, do wonderful 

works. We can gather a wealth of information from the sketches and displays put 

up on the walls of a BHU. We need to do more with less resources and incentives 

such as TA/DA and remuneration benefits. Making a person feel good and saving a 

person from suffering of cancer through health promotion activities will pay you a 

rich dividend in your life now and after this life. 

19. Mindful of the ever increasing health care expenditure, we must also be prudent and 

austere in the use of medical supplies and take great care of the equipments so as to 

prolong their lives. 

20. I am happy that some hospitals like Bumthang are taking initiatives making all the 

staff clean their hospitals every Saturday. At the end of the day, what matters is 

the cleanliness of the hospitals, which compensate most of the shortage of drugs 

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and other facilities. In my address to the second medical conference, I highlighted 

that 17.7 million infections are contracted in the hospitals per year in USA. Imagine 

the situation in a Bhutanese hospital where we are liberal in allowing our patients 

and attendants to eat home-made meals in the wards and, walls and floor corners 

are littered with doma spits and other dirt. Lets us support the initiatives taken by 

some hospitals and make it a regular activity. This will serve as good demonstration 

and illustration in our efforts to promote sanitation, hygiene and cleanliness in 

communities. 

21. This is the information age. Our King and also Prime Minister keep reminding 

us that we aspire to be a knowledge based society. ICT development is a key to 

achieving this aspiration. We have launched IT Park in Thimphu. The Government 

has implemented the Chiphen Rigphel Project. The Ministry of Health was far ahead 

of others in introducing Telemedicines and Tele Health. But, sadly, we are not able 

to make best use of this facility. We have invited a WHO consultant to review the 

programme and come up with the recommendations including as to how we can 

integrate telemedicines into HHC using the same software. To benefit from this 

bonanza, there should be constant contact, interaction and interfacing using ICT 

or telemedicines or telehealth or HHC between and amongst BHUs and hospitals 

district-wise and then with regional and national referral hospitals. This plan, I 

hope, will be discussed in one of the committees for reflecting in the 11 th five-year 

plan. This will not only ease the shortage of doctors but will help patients not to 

travel a long distance, which aggravates the condition of patients. The network will 

create the environment which will allow all health workers to interface, exchange 

experiences and, in the process there will be enhancement of professional and clinical 

competence. 

22.Irrational prescription is posing a serious threat to public health system. It is one of 

major causes for the development of Antimicrobial Resistance (AMR). If we prescribe 

a high end antibiotic for a minor illness now, what do we give when that patient 

suffers from more serious illnesses later because he or she has developed AMR. It 

is our duty to ensure that we prescribe rationally and sensitize the people on AMR. 

Multi drug resistance to TB is a classical case in point. 

23. From my regular interactions with health professionals formally and informally 

and observations in the past three years, I am perturbed by some kind of inefficient 

system that is prevalent in the diagnostic procedures beginning from history taking 

through patients’ examinations to laboratory investigations. Misdiagnosis is one of 

the leading causes of patient suffering and in some cases, death. My appeal to all 

medical and health professionals is to address this problem more professionally to 

minimize the suffering of patients. 

24.Time and again I have been sharing with our health professionals about the broad 

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errors doctors make mainly in the areas of diagnosis, patient management or 

medication procedure and surgical procedures. My observations confirmed by 

medical literature I have read on the common mistakes doctors make has become 

a source of serious concern. I shall appreciate if this conference could find time and 

space to discuss on this serious issue. This must be regularly and seriously discussed 

in the monthly clinical and mortality meetings of hospitals and health centres. 

25. Finally, from my working with you for the past three years I am convinced that 

you have the capability and commitment to take our health system and health 

service to a greater height. Given that Health is a major cause for either happiness 

or unhappiness of our people, I once again appeal to all health workers to continue 

to give your best in making Bhutan a truly happy and healthy society. I have less 

than two years to work with you and I will continue to strive to provide necessary 

support, as I mentioned already, in your efforts to deliver high quality health services 

to our people with respect, care, compassion and dedication. Our primary health 

care system is widely appreciated and we can be a model in overall health care 

system. We have the right environment. We have the kind guidance and support 

of our King, our Government and our people and development partners to work 

towards this noble goal. 

Tashi Delek. 

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Annexure 2- Welcome Address – DR. DORJI wangchuk, DG-DMS 

Hon’ble Chief Guest, Sowia Lyonpo, Esteem Members of the Parliament, Ven. 

Lam Netan, Dasho Dzongda, Mongar, Professor Kozo Matsubayashi Kyoto University, 

Ladies and Gentlemen. 

This is the second time that we are conducting A Health Conference, a major 

health event in a calendar, away from Thimphu and is the first time being hosted 

by Mongar Dzongkhag the first Biennial health conference. Historically taking 

place in East. We are excited as well as confident that by grace of god and the 

blessings of the local deities that the event will be most pleasant & memorable 

one. 

At this delightful moment I am privileged to offer this welcome note. 

This is a moment to reflect on the past and contemplate upon the Future. We, in 

health had seen all kinds of tribulations, but were with sole motive of serving our 

people in the best of our abilities. 

We learnt that our predecessors had one thing in mind was to do their best for 

the people who were sick and needy. They explored the inhospitable terrains of 

ours. Walked all across the country and braved all odds to save lives. Nothing 

deterred them. Neither fear nor selfishness existed. They saw the same vision as 

did our benevolent Kings. 

When many people died of Smallpox epidemics, they were unhindered by the 

fear of death, went and vaccinated the entire country. They had limited technical 

capacity. When the world declared smallpox free we did too despite all the odds. 

This lesser known country of ours built health system as we started to exist. Our 

little rustic Florence Nightingales were borne out of world of innocence. They 

strived days and nights with patients in difficult situation with dreadful diseases. 

They were few in numbers. They were not even highly qualified- most just read 

up to class I or II. But they did excellent job of tending the sick with utmost dedication. 

We are humbled by them. 

I welcome, you to offer salutation to our bygone stalwarts and reflect upon the 

health system they had built. 

I welcome, you to reminisce over one person’s deep commitment, Her Royal 

Highness Grandmother Ashi Kelzang Choden Wangchuck who helped build 

health system and was pivotal in uprooting the scourge of leprosy from our 

country. We still continue to receive her Royal patronage; one of the recent suc- 

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cesses in health is the introduction of HPV in the country. We must pay our 

homage to Ashi Kelzang Wangmo Wangchuck for her unstinted support to the 

social care of our patients. We also dedicate ourselves to Queen Mother Ashi Sangay 

Choden Wangchuck for her greater involvement for the cause of HIV/AIDS, 

teenage pregnancies and cervical cancer. 

Health system reached thus far is culmination of concerted effort of everyone involved. 

Bhutanese health system is now accepted by many pundits in the region. 

We have achieved so much with so little time and resource. It is not just smallness 

of size but something larger we inherited. Our endeavor to be self reliant lead to 

creation of our own training institutes and built our own strengths. Our approach 

to health had been uniquely adapted Primary Health Care which penetrated into 

the most difficult areas. This made everyone health worker to be committed for 

a greater cause, then just to health. A solitary health assistant would not mind 

sitting by dim kerosene lantern, middle of night, in a desolate place waiting for 

patients. The lonely basic health worker would walk days to immunize just one 

child at desperate village. A contingent of such health workforce pioneered and 

helped us reach at this pinnacle. 

While we chant our laurels we must squarely look at our FAILURES too. The 

conference is an opportunity to step back and understand the mile post we 

crossed. While moving forwards we must look backwards. 

Ladies and gentlemen, I welcome, you to feel with us as we plot through an unknown 

trajectory with our own doctors, nurses, technicians, which then used to 

be mostly through hired personals from other countries. It is good to provoke 

ourselves and see if we are confident enough to take our health system to higher 

echelons. 

It is time to do some soul searching and imagine how best we can handover to 

our successors. 

Of late, we in health have been going through serious convulsions; hope it is just 

a petit mal seizure, but our staff at all level had been resilient and never stopped 

providing required services despite shortages and restrictions. While we climb 

to top of a snow clad mountains we have to risk frostbite and loss of limb. But we 

must reach the top at all cost. We are accountable for the health of our people. We 

must by all means maintain our pioneer architects had promised. 

Ladies and gentlemen, it is proving to be difficult to offer the best at free of cost. 

Rising demand on already limited resources and being sole supplier of health 

we land ourselves at cross-roads most frequently. Everything must come from 

outside and regulations are so stringent that the kind of quality care we wish to 

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provide become unrealistic. We are slightly better in terms of health manpower 

but not enough to satiate our need particularly specialists and GDMOs. In order 

that our hospitals become acceptable and good, must have good doctors to run it. 

They must be supported by good set of nurses, technicians and other nonclinical 

support systems. This conference gives us opportunity to understand our system 

better and dive deep to feel more responsible at one’s own level. 

It is time to recapitulate our attitudes in the care of our patients. Can we be more 

responsible to manage with limited resources? Do we understand the health 

spend should mean additional benefit to our people? 

As we move away from donor dependent health system more research and innovations 

will be required. This conference is opportunity to check our commitment 

towards a more comfortable and realistic system. 

We have to renew our thought processes to build a stronger government health 

system in order to challenge upcoming private sector provision. It is time to reflect 

again and again to find better solution. 

This is one opportunity, as we assemble in an arena to fight positively to find out 

the best solutions in our own little way. 

I welcome you to engage in health. 

This year’s theme of the conference it is pertinent enough to understand the final 

diagnosis of the pathological state before administering medication!!! This means 

quality all around. 

I am confident that with many young and energetic participants we can rejuvenate 

our body, mind and soul. This conference will surely guide us build a better 

health system. 

Hon’ble Chief Guest you being at the helm will steer the path to higher levels of 

successes. We are proud to have you among us. 

Thank you, Tashi Delek 

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Annexure 3- 2009 AHC recommendation follow-up 

1. To reduce administrative burden and exercise cost cutting measures all the 

participants agreed to institute measures in their respective work place. 

Several activities inline with this recommendation were pursued. Chief among them being: 

1. All Annual Work Plan were discussed with relevant head of departments and 

with PPD 

2. The DVED procurement system was reformed 

3. Outsourcing of non-clinical services at JDWNRH were initiated 

2. The ambulance policy guideline was endorsed for implementation. Possibility 

of hiring utility vehicle may be explored wherever necessary. 

The Ministry has proposed for 26 numbers of utility vehicle to the Royal Government 

of Bhutan to which the Cabinet has approved. The vehicles are expected to arrive in the 

country by December 2011. 

3. 

a) Department of Public Health and Dzongkhag Health Sector should work 

together in meeting the polio surveillance indicators as per the WHO guidelines. 

The Dzongkhag Health Sector should assess the target population for 

immunization to avoid the current problem of reporting more than 100% 

coverage. 

Polio surveillance indicator for AFP rate has increased to 2.83 in 2010 from 0.46 in 2009. 

The target as per the WHO guideline is to have AFP rate above 2. 

Adequate stool samples collection rate has reached to 67% in 2010 compared to nil in 2009. The 

10th FYP target is to achieve above 80%. 

To avoid the current problem of ‘reporting more than 100% immunization coverage’, the 

respective Dzongkhag Health sectors have been asked to maintain separate information for those 

people visiting from other Dzongkhags. 

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b) ICB should develop IEC materials with regard to polio both in English and 

Dzongkha. Advocacy should be conducted during DT and GT by Dzongkhag 

Health Sector. 

Polio posters both in English and Dzongkha were produced in consultation with VPD 

program. The posters were also distributed to all district hospitals, BHUs and ORCs 

through DVED. 

A month long media (broadcast and print) campaign was conducted on good hygiene 

practice for preventing polio virus. The campaign also stressed on the importance of receiving 

polio vaccine. 

4. Policy and Planning Division should come up with implementation guideline 

with regard to channeling of funds, decentralization of health activities 

and packaging of in-service training for all categories of health workers 

during the result based planning workshop for the Dzongkhag Health Officers. 

A Results Based Management Workshop was conducted in Punakha for DHOs of all 

20 Dzongkhags where all these issues were deliberated upon. In collaboration with 

GNHC, fund channeling modalities were improved to speed up the activities. With 

regard to decentralization of activities, after the Punakha workshop, only two activities 

were received from Samdrup Jongkhar. 

5. 

a) Department of Public Health to conduct a study on the co-relation between 

water coverage and water borne diseases and to present the findings in the 

subsequent Annual Health Conference. 

The proposal to conduct a study on the co-relation between water coverage and water borne 

disease was forwarded to WHO SEARO. WHO SEARO reviewed the study proposal and 

discussed with Research and Epidemiology Unit. The protocol has been finalized. Due to 

inadequate fun for field work, the study could not be carried out. However, during the recent 

presentation on findings of Bhutan Multi Indicator Survey (BMIS) by NSB, it was agreed 

to assess the co-relation between water and sanitation coverage to related diseases from the 

available survey data. The assessment will be done during programme Thematic Analysis to 

be conducted in later part of 2011. 

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b) Public Health Engineering Division to explore to conduct hydrology study 

in collaboration with relevant sectors in order to understand the sustainability 

of RWSS. 

PHED consulted with all the relevant agencies such as Hydromet Services Division 

(HSD) Department of Energy, Department of Geology and Mines (DGM) and National 

Environment Commission on hydrology information. To date no study on water resources 

in the country has been conducted. However, NEC as the apex body for water resource 

management is planning to maintain an inventory of the water sources across the country 

as the first step. They also have plans to conduct a major study on the water resources 

in the country. Once the information on water resources is available, it will facilitate to 

ensure better selection of drinking water sources and ascertaining the sustainability of 

water supply schemes 

c) Selected RWSS focal engineers from the Dzongkhags be invited in the future 

Annual Health Conference. 

Relevant engineers from eastern Dzongkhags are being called to attend the session on 

RWSS. 

6. The introduction of Pentavalent vaccine and dzongkhag participants 

pledged their commitments. Department of Public Health to report on the 

implementation status in the 2010 Annual Health Conference. 

The pentavalent vaccine was introduced on 1 st September, 2009 and was suspended on 23rd 

October 2009 following a temporally related Adverse Events Following Immunization (AEFI). A 

detailed investigation by the national and international experts declared that the vaccine was safe. 

Subsequently, the Pentavalent vaccine was re-introduced on 11th june 2011. As of June 2011, 

118 infants were vaccinated with Pentavalnt vaccine. 

7. Human Resource Division to form a committee comprising of Dzongkhag 

representatives to refine the transfer guidelines and the implementation 

status be presented in 2010 Annual Health Conference. 

A transfer guideline on rational deployment of staff was developed and sent to the Dzongkhags 

for comments in 2009. As discussed during the Annual Health Conference 2009, 

the guideline developed would be considered “as accepted” if the Ministry does not receive 

comments after one month. Subsequently, upon not receiving any comments from 

Dzongkhags, the HRD implemented the guidelines. 

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8. The Human Resource Division should explore the possibilities of converting 

the community health workers to hospital nurses who have been working 

for a long time in the hospitals and not being able to be transferred to 

the BHUs and report the implementation status in the next Annual Health 

Conference. 

Under the Position Classification System, there is specific requirement of qualification 

for each position. Therefore, the Health Assistants and Basic Health Workers cannot be 

converted to GNM (Staff Nurse) or Assistant Nurse since the qualification requirement 

including pre-service training is different for every category. Therefore, the PCS position 

directory does not permit this mismatch and the Ministry is not able to consider the 

conversion of Community Health Workers to hospital Nurse. 

9. 

a) All unused equipment and instruments in BHUs be collected by Dzongkhag 

Health Officer and pooled at the dzongkhag hospitals which will be 

collected by DVED. 

Due to time constraints and other important engagements, the division has not been in 

the position to collect the unused equipments and instruments from the central and eastern 

Dzongkhags. 

b) The quantification of the medical supplies should be reviewed and signed 

by the respective head of the health facilities. 

The reviewing and approval system of quantification of medical supplies by respective 

heads of the facilities is put in place by the DVED 

c) Log book should be maintained by all health centers for equipment costing 

Nu.50,000 and above and Department of Medical Services should monitor. 

Log Books are being maintained and is being monitored regularly. 

10. Human Resource Division to process for medical allowances for the Pharmacy 

Technicians for Medical Supply Depot and Drugs Vaccines and 

Equipment Division with RCSC for approval. 

The Medical Allowance rules of the Ministry of Finance mentions that only medical 

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professionals engaged in clinical practice are eligible for such allowance. Moreover, the 

Pharmacy Technician in MSD and DVED are designated as Assistant Procurement 

Officer and is not covered by this rule. However, they can avail promotion till P2 A, while 

the Pharmacy Technicians promotion gets stagnant at P5 A. This was also discussed 

during the 14 th HRC of the Ministry on 20 July 201. The DVED and MSD were informed 

of the decision vide letter no. MoH/HRM/DoMS/02/2011/1170 dated 31 August 2011. 

11. Maternal and Neonatal Mortality Review Committee should be instituted 

at the Dzongkhag level chaired by Dzongkhag Health Officer. All maternal 

and neonatal deaths should be reported through DHO to Department of 

Public Health and the implementation status to be reported in the next Annual 

Health Conference. 

The Reproductive Health Programme under Department of Public Health has instituted a 

District Maternal and Neonatal Mortality Review Committee right after the AHC 2009. 

The members of the committee includes: DHO as chairman, DMO, MCH staff, labour 

room in-charge, EmONC focal persons, Gynecologist and Neonatologist/Pediatrician (if 

available). The guideline on the roles and responsibilities of the committee were also developed 

and circulated to the districts. The roles and responsibilities in brief include: 

• Arranging for maternal and neonatal deaths investigation as and when occur 

• Conducting quarterly review of maternal and deaths 

• Gene+rating appropriate recommendations at the district level 

• Submitting quarterly maternal and neonatal death reports to the ministry 

12. 

a) The processes for implementation of medical certificates guidelines and 

disciplinary proceedings for medical malpractice and negligence regulations 

be reviewed. 

As recommended the issues was discussed with the technical experts and changes were 

incorporated. 

b) To review the CME crediting mechanisms and the total credit points for 

all categories of health workers including Drungtsho’s and Menpas. 

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The total credit hours is reduced to 3 from 6 hours per credit 

13. JDWNRH should adequately budget for the National Clinical Conference 

to be conducted annually; and Dzongkhag Health Sector should also budget 

to meet the cost of travel for their participation. 

The fund for the 2nd medical conference was mobilized by the Ministry from its program. 

14. The central monitoring and supervision checklists should be implemented, 

however the checklist being developed for the Dzongkhag should be finalized 

and implemented. The implementation status and the impact should 

be presented in the subsequent Annual Health Conference by Policy and 

Planning Division. 

The monitoring and evaluation system will be further discussed in the parallel sessions 

on November 9, 2011. 

15. In recognition of the significance and the importance of the research especially 

on operational research, the secretariat and Dzongkhag should keep 

certain percentage of budget to gear towards the improvement of services. 

Research Unit has mobilized finds from RGoB and WHO to meet the 10FYP mandates 

of research. However, the BHC 2011 needs to reiterate Dzongkhags and programs to allocate 

at least 1% of their total funds for research development. 

16. The staff welfare fund should be audited annually and present report to 

the following Annual Health Conference and the Board should ensure its 

implementations. 

The HSWS fund is currently being audited by the Royal Audit Authority. 

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AGENDA FOR BIENIAL 

HEALTH 

CONFERENCE 2011 

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AGENDA FOR BIENIAL HEALTH CONFERENCE 2011 

Time Event Agency Venue 

7 th November, 2011 Pre Conference 

0800-0830 Participant Registration 

0830-0930 

1. Poster Presentation of 

NHP, NHA, Costing of 

Healthcare and GIS 

2. Health Financing; and 

3. 11FYP framework 

School health Services 

0930-0945 

0945-1030 Tea Break 

Poster Presentation 

Kado Zangpo-PPD 

Sonam Pelden 

Wangchuk 

Hotel 

Wangchuk 

Hotel 

1030- 1130 

1. Follow up on status of 

Diseases Surveillances in the 

districts 

Sonam Wangchuk, 

PHL 

1130-1200 

2. Presentation on water 

quality monitoring in 

district 

Addressing Health Data Gaps 

Tshering Jamtsho 

HMIS 

Wangchuk 

Hotel 

1200-1300 Lunch Break 

1300-1330 

Strengthening PMTCT and 

procurement of ARV drugs 

Namgay Tshering 

HIV/AIDS 

Wangchuk 

Hotel 

1330-1400 

Briefing on roles and responsibilities 

of EMTD 

Dr. Karma Lhazeen- 

EMTD 

1400-1430 

Planning an evidence based 

annual cycle of QI for the 

health services in Bhutan 

Dechen Choephel- 

QASD 

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1430-1500 

Population based Cancer Registry 

&??? 

Dr. Ugyen Tsomo 

(HOD-OBGYN-JD- 

WNRH) 


1530-1630 Sensitization on HHC and IT ICT 

Wangchuk 

Hotel 

1630-1700 BMHC 

BMHC 

8 th November, 2011 Main Conference 

Theme “Strengthening Health Systems for Quality Care” 

0800-0815 

0815-0830 

0830-0845 

0845-0900 

0915-0945 

Inauguration Session: 

All Guest to be Seated 

Arrival of Chief Guest; 

Marchang Ceremony; 

Welcome address Inaugural 

Address by Hon’ble Chief 

Guest; 

Dzongdag 

(Mongar) 

Oftg Secretary 

Hon’ble Minister 

Wangchuk 

Hotel 

0945-1000 

Vote of Thanks 

Director DoPH 

1000-1030 Photo session & Hi Tea 

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1030-1100 

1100-1115 

1115-1145 

1145-1200 

Opening Remarks stressing on 

future health system 

Follow up recommendation of 

HC-2009 

Overall prospective of Health 

System ; 

Adoption of agenda and selection 

of rapporteur 

Hon’ble Lyonpo 

Ugyen Wangchuk 

PPD 

DG, DMS 

Organizer 

Wangchuk 

Hotel 

1200 -1300 Lunch Break 

1300 -1330 

Divide the participants into 2 

Committees (A & B) 

Chairperson Committee A- 

DG,DMS 

Chairperson Committee B- 

Director, DoPH 

Wangchuk 

Hotel 

1330-1430 

Committee A (DG,DMS) 

HRD Issues ( Mrs- Yangchen 

Chief HRO) 

Committee B (Director, 

DoPH) 

Health Infrastructure 

(Wangdi Gyeltsen 

PD-HIDD) 

Wangchuk 

Hotel/DYT 


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1500-1600 

Health Promotion, Community 

participation and inter 

sectoral collaboration 

(Wangchuk Dukpa- DoPH) 

Procurement , Drugs 

and Supplies 

(Tandin-DVED) 

Wangchuk 

Hotel/DYT 

1600-1700 

Nutrition 

(Ugyen Zam-Nutrition program) 

Inventory and Maintenance 

(Mr. Tshering-BME)) 

1700-1800 

MMR & Maternal and Neonatal 

Death InvestigationSonam 

Wangdi-RH Program) 

Monitoring and 

Evaluation system 

1900-2100 

DINNER 

(Rinchen Namgyal- 

DMS) 

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9 th November 2011 

Plenary : 

0830- 0900 

0900- 0930 

Report on Current status of Poliomyelitis 

eradication. 

New Vaccines and schedules (Year 

of intensification for Immunization) 

Polio Commission. 

EPI (CPO CDD) 

Wangchuk 

Hotel 

0930- 1000 Mr. Ugyen- 

MDG 7 ( Sanitation ) 

RWSS 

1000- 1030 

Tea Break 

1030- 1100 Report on HSWS Director DoPH 

Wangchuk 

Hotel 

1100- 1200 Appraisal on elderly care 

Professor Royota 

Sakamoto 

1200- 1300 Lunch 

1300- 1400 

Presentation of Recommendations: 

1. ITMS conference recommendation; 

2. 2 nd Medical Conference 

Dungtso Tshering 

Tashi (ITMS) 

Medical Director 

JDWNRH 

Wangchuk 

Hotel 

1400- 1500 

Presentation on the recommendations 

of the Pre Conference and the 

Committee meetings; 

Rapporteur 

1500- 1530 Tea Break 

1530- 1630 

Finalization of the recommendations. 

Wangchuk 

Hotel 

1630- 1700 Closing Remark Hon’ble Lyonpo 

1830- 2100 Dinner with Cultural Program 

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BHC 2011-Participant List 

DoMS: 

1. Dr. DORJI Wangchuk, Director General: 

2. Mr. Nawang Dorji, Chief HCDD 

3. Dr. Karma Lhazeen, EMTD 

4. Mr. Rinchen Namgyal, Sr. Program Officer 

5. Mr. Tshering Dorji, BES 

6. Ms. Soira Sonam Taang, BES 

7. Mr. Tandin, DVED 

8. Mr. Tashi Lhundup, DVED 

9. Ms. Deepika Adhikari 

10. Mr. S.B Gurung, HIDD 

11. Drungtsho Tshering Tashi, ITMS 

12. Mr. Kinga Jampel, PRU 

13. Professor Kozo Matsubayashi 

14. Professor Kiyohito Okumiya 

15. Professor Ryota Sakamoto 

DoPH: 

1. Dr. Ugen Dophu, Director 

2. Mr. Tandin Dorji, Chief NCDD 

3. Mr. Ugyen Rinzin,Dy,executive engineer 

4. Mr. Namgay Tshering,PO 

5. Mr. Sonam Wangdi,PO 

6. Mr. Sonam Palden,PO 

7. Mr. Sonam Wangchuk,Head PHL 

8. Mr. Leki Dorji, ICB 

Secretariat: 

1. Ms. Yangchen Chhoeden,Chief HRO 

2. Mr. Khampa Tshering,Dy. Chief HRO 

3. Mr. Mindu Dorji,HRO 

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4. Mr. Tshelthirm Zangpo,HRO 

5. Ms. Gaki Tshering,Head, ICT 

6. Mr. Kado Zangpo,CPO, PPD 

7. Mr. Jayandra Sharma ,PO, PPD 

8. Mr. Tshering Dhendup, Sr.PO, IHR 

9. Ms. Dechen Choden, CAO, AFD 

10. Mr. Ugyen Tshewang, DCFO, AFD 

11. Mr. Sonam Leki, CIA, AFD 

12. Mr. Dechen Chophel, CPO, QASD 

BMHC: 

1. Dr. Pandup Tshering, Registrar 

RIHS: 

1. Dr. Neyzang, Lecturer 

JDWNRH: 

1. Dr. Duptho Sonam, Medical Superintendent 

2. Dr. Ugyen Tshomo, HOD 

3. Ms. Tandin Pemo, Nursing Superintendent 

Polio Commission members: 

1. Mr. Phub Rinchen 

2. Mr. Penden Dorji 

National Council/Assembly: 

1. Dasho Jigme Rinzin 

2. Dasho Tshering Tenzin(NA) 

3. Dasho Karma Lham 

Other Organization: 

1. Mr. Kinley Dorji ,Executive Director, BNCA 

2. Mr. Sonam Dorji ,Drug Controller, DRA 

3. Ms. Nelima S. Rajpakra, WHO S.T Consultant 

4. Dr. Nar Bahadur, CEO- HHC 

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UN Agencies: 

1. Ms. Calire vander Vaeren, UN Resident Coordinator 

2. Mr. Yeshi Dorji, ARR 

3. Mr. Thinly Dorji,NPO 

Rappoteurs 

1. Mr. Ugyen Wangchuk,PO 

2. Mr. Tandin Dendup,APO 

3. Mr. Tshering Wangdi,APO 

4. Ms. Kinzang Wangmo,PO 

5. Ms. Sonam Yangchen,APO 

6. Mr. Tshering Jamtsho,RO 

AV & IT Support 

1. Mr. Tshewang Dorji,ICB 

2. Mr. Nima,ICB 

3. Phub Dorji,ICT 

4. Birju Sunwar,ICT 

District Participants 

1. Mr. Pema Tshawang, MRO, Bumthang 

1. Mr. Kinzang Namgay,DHO, Bumthang 

2. Dr. Tshering Tamang,MO, Chukha 

3. Mr. Tshewang Rinzin,DHO, Chukha 

4. Dr. Kinley Wangdi,Superintendent, Phunthsoling Hospital 

5. Mr. Yeshi Nidup,DHO, Phuntsholing 

6. Dr. Kipchu Tshering,MO, Dagana 

7. Dr. Sanjay KV.Pradhan,Offtg.MO, Gasa 

8. Mr. Rinchen Dorji, DHO 

9. Mr. Gem Dorji,DHO, HAA 

10. Dr. Pema Tenzin,MOI, HAA 

11. Dr. Thinley Pelzang,MO, Lhuntse 

12. Karma Wangchuk,DHO, Lhuntse 

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13. Dr.Tapas Gurung,M Superintendent, Mongar 

14. Mr. Tshering Dorji,DHO, Mongar 

15. Mr. Ugyen Tenzin, Pharmartist, Mongar 

16. Mr. Namgay Dorji, EPI, Mongar 

17. Dr. Choeda Gyelshen,MO, Punakha 

18. Dr. Rinzin,MO, Paro 

19. Dechenmo,DHO, Paro 

20. Dr. Thukten Chophel,MO, Pemagatshel 

21. Mr. Sonam Dorji,DHO, Samtse 

22. Dr. Chador Tenzin,MO, Samtse 

23. Mr. Tshewang Phuntsho,DHO, Samdrupjongkhar 

24. Dr. Ugyen Wangdi,MO, Samdrupjongkhar 

25. Mr. Choki Gyeltshen, DHO, Sarpang 

26. Mr. Tshewang Gyeltshen,ACO , Sarpang 

27. Dr. Lobzang, MS, Sarpang 

28. Mr. Pema Wangchuk,DHO, Tsirang 

29. Dr. Tegnath Nepal,MO, Tsirang 

30. Dr. Tashi Wangchuk,CMO, Trongsa 

31. Mr. Gunjaraj Gurung, DHO, Trongsa 

32. Mr. Tshewang Dorji, DHO, Trashigang 

33. Dr. Gyan Prasad Bajgai,MO, Trashigang 

34. Ms. Kinzang Lhadon,HA, Trashigang 

35. Mr. Karchung,ADHO, Trashigang 

36. Dr. Abi Narayan Pradhan,MO, Trashiyangtse 

37. Mr. Sonam Chophel, ADHO, Trashiyangtse 

38. Mr. Dorji Chewang,DHO, Thimphu 

39. Mr. Dorji Gyelshen,DHO, Wangdue 

40. Mr. Phuntsho Dorji,MO, Wangdue 

41. Mr. Karchung,DHO, Zhemgang 

42. Dr. Kinley Penjor,MO, Zhemgang 

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Organizer team: 

1. Dr. Lungten Z. Wangchuk,Research Unit 

2. Mr. Norchen Tshering,AFD 

3. Mr. Rahar Singh,HIMS 

4. Mr. Dopo,HIMS 

5. Ms. Tshering Choden,LO 

6. Ms. Pem Zam, DoPH 

7. Ms. Ugyen Zangmo,DoPH 

8. Ms. Karma Dolma, DoPH 

9. Mr. Wangchuk,AFD 

10. Mr. Namgay Dorji,AFD 

11. Ms. Kinley Om, Research Unit 

12. Ms. Sonam,AFD 

13. Ms. Chimi Dema,AFD 

14. Ms. Kuenzang Choden,HRD 

15. Ms. Dolma Tshomo,PHED 

16. Mr. Tashi Duba,DOMS 

17. Mr. Pema Wangdi,PHED 

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Biennial Health Conference 2011 - Ministry of Health

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