Human resource is the core of any health care system.

Our health workers have been critical in the country’s progress in maintaining the health and wellbeing of the population. Built on a strong foundation of primary healthcare system, Bhutan has been able to meet most of the healthcare goals.  National surveys show that more than 90 percent of the population is satisfied with the healthcare services.

But a recent survey found that although 68 percent of healthcare providers in Bhutan are satisfied with their job, more than 50 percent of them were dissatisfied with career enhancement opportunities (CME) such as ex-country trainings, promotion system, and staff quarter allocation. A whooping 86 percent was specifically unsatisfied with ex-country CME opportunities.

For the country to sustain the progress it has made to date, it must keep its workforce motivated. It becomes important for policy makers to understand where the satisfaction or dissatisfaction is coming from. For instance, only 31 percent of health workers were satisfied with the career enhancement opportunities and 56 percent with their salary and incentives. But the same health personnel reported 85 percent satisfaction in workload and facility management.

These findings are worrying and call for a review of the process that is taken to give these opportunities. Health workers in the periphery are considered the backbone of primary healthcare services. But when it comes to availing ex-country tours, it appears that those in the headquarters are travelling more.

Between July 2015 and June 2017, the health ministry processed nominations for 1,120 health workers for short-term training, meetings and long-term training. Out of this, 983 were for short-term training and meetings. This means 40 health workers attended a meeting or training each month or, one health worker everyday.

During this period, 146 health workers from the dzongkhags were nominated for short-term training and meetings, which is one dzongkhag health worker each month. This could confirm the grievances of health workers that reported dissatisfaction with their jobs               .

Even as we would like to believe that the human resource committee has been considerate in its nominations, these numbers show that nominations are skewed towards the headquarters.

Perhaps it is due to the nature of work and the kind of opportunities available that programme officers top the list of ex-country training among non-clinical staff. Among the clinical staff, technicians, followed by specialists and health assistants, tops the list. While it may not be practical to compare the level of job satisfaction between clinical and non-clinical staff, it becomes important to assess why health workers are aggrieved in terms of availing opportunities. Perhaps, they believe that the spirit of decentralisation and equity doesn’t apply when it comes to ex-country opportunities.

But a more worrying finding from the survey was doctors reporting the least level of job satisfaction. Only 21 percent of the doctors felt fairly compensated with their scarcity/technical allowance as well as payment for their current position.

Job satisfaction is identified as a key factor in influencing performance of individuals and organisations. For the health sector, which sees a high turn over of trained clinical staff, a dissatisfaction rate such as this could affect service delivery. The findings show that there is a lot more to be done to strengthen the morale of our health workers.