Other side of an Autonomy - view from below

Bhutan is known for her pursuit of Gross National Happiness as the development goal, otherwise, a tiny Himalayan Kingdom sandwiched between two populous nations of the world, China and India. This has been further propelled by explicit provision of welfare policies that the state and the government of the day ought to implement as provided in Article 9, Principles of State Policy of the Constitution of the Kingdom of Bhutan, 2008. In that context, free education up to the tenth standard and free access to basic health services should be provided by the state to all walks of life in all times to come.

Very recently, His Excellency, the Prime Minister of Bhutan during the State of the Nation Report, as stated in Kuensel Issue of 1^st October, 2013 pledged to grant autonomy to Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) located in Thimphu. While this may seem in compliance with People’s Democratic Party’s ideology of ‘decentralization’ to which His Excellency was unequivocal during public campaign as well as after forming the government, this move may affect the poorer and poorest section of the Bhutanese populace.

Differences between the Ministry of Health against Administration and Doctors of the JDWNRH could be one probable cause for the move while the status of autonomy would also ensure greater efficiency and speedy delivery of services and other related works. On the other hand, with autonomy, State’s allocation of financial as well as human resource would be limited. There in, sustainability issue will arise. Consequently, the Hospital will be compelled to find its own way out. As Bhutan is developing at the fast pace, international donors are withdrawing their support from Bhutan in order to reach the helpless and voiceless ones who are in appalling conditions in other parts of the world. In such a milieu, charging and levying taxes on some services would only solve the problem of sustainability.

Two to three years ago, Royal University of Bhutan (RUB) was delinked from the parent Ministry of Education. No sooner did the RUB become autonomous than Colleges under it confronted the issue of ‘sustainability’. To nip it at the bud, decisions were reached involving RUB and the administration of the member colleges. Amongst others, students are to pay to re-appear the failed paper. The amount differs, in Sherubtse College, for one failed paper, one is required to pay not less than Nu. 7, 000/- and even higher depending on the subject failed. The justification for imposing such huge amount is to make students study hard. While this could be true, at times unforeseen emergencies during the time of examination would undo even the outstanding students. Most compelling situation amongst many is the brunt the children of the poor and agrarian parents have to bear with. Back in the villages, their parent’s month long labour in quest of hard currency hardly earns Nu. 4, 950/- a month, considering the National Minimum Work Force Wages of Nu. 165 a day provided the regulation is complied with. Students from the lower economic strata of the society are hardest hit of.

Should JDWNRH be granted the autonomy and subsequently follow the precedent set by the RUB, then, the provision of free basic health services would be the story of the past. Article 9, Section 21 of the Constitution of the Kingdom of Bhutan envisages, “The State shall provide free access to basic public health services in both modern and traditional medicines”. In that context, considering the standard of the hospitals and the Basic Health Units across the Country, two Regional Referral Hospitals in Mongar and Gelephu would not be in a position to cater the needs of the people of all twenty Districts. The change in the definition of ‘basic’ and ‘free access’ would be the probable solution?

My opinions would be ‘miscalculated and ill-conceived’ one, but it has significant bearings to some sections of the people if not all. To reach upon the RUB decision on the payment to be made to re-appear the failed paper and to fix the amount, students were never consulted. Even the grievances expressed ‘seem’ to be least bothered. In the same light, it is essential to clearly explain to the common people the fate of the autonomy of JDWNRH and their opinions considered, before it is declared autonomous. This would create informed citizen well in position to adjust with the changes brought in within the system. Further, decision making procedure needs to incorporate ‘bottom-up approach’ as much as ‘top-down approach’ is being put at work. Beside these, modus-vivendi is an important prerequisite among the institutions and various stake holders in the Bhutanese system for greater harmony and efficiency.

Written on Friday, 25^th October, 2013 corresponding to 21^st Day of the Ninth Month of Water Female Snake Year of Bhutanese Lunar Calendar