title: Quality assurance of the university medical education, hospital services and traditional pharmaceutical products of the Bhutanese So-wa-rig-pa health care system.
abstract: BACKGROUND
  The Bhutanese So-wa-rig-pa medicine (BSM) was integrated with the allopathic (modern) health care system in 1967. Ever since the health care integration policy was implemented, the BSM has gone through many phases of quality improvement and changes including the establishment of one university-based institute, 58 hospitals and Basic Health Units (BHU)-based health care services, and one traditional medicine factory. The BSM provides primary health care services to more than 20-30 % of patients who visit hospitals and BHU on a daily basis. However, there has been no study covering the quality assurance system of BSM. Our paper addresses this information gap.
  
  
  METHODS
  This study was an observational ethnographic study supported by phenomenological understanding and content analysis of the data. The information was triangulated through consultation with the BSM practitioners (discussion (N = 8)) and personalized in-depth question-answer sessions using electronic protocols (N = 5). These participants comprised BSM educationists, clinical physicians, researchers, production and the quality assurance staff who were selected using convenience and purposive sampling method. The relevant So-wa-rig-pa information and literature were obtained from the government policy documents, official websites, scientific papers and the traditional medical texts. This study is enhanced by our practical observations and first-hand experience with BSM while working as the researchers at the Ministry of Health in Bhutan. In addition, the information in this paper is crosschecked and authenticated by five So-wa-rig-pa practitioners of Bhutan.
  
  
  RESULTS
  The study highlights the following: a) The BSM receives both the government and people's support, b) The quality assurance system have been developed by integrating the traditional empirical knowledge and modern scientific protocols, c) There exist three administrative and functional organizations responsible for providing the quality BSM health care services in Bhutan, d) Extensive standard treatment guidelines and Quality documentation system exist for BSM as required by the regulatory bodies in Bhutan. The paper also recommends appropriate future directions for BSM.
  
  
  CONCLUSIONS
  The BSM plays significant role in the primary health care system of the country. Consequently, the quality, safety and efficacy of BSM has been given priority by the Bhutan government. Many scientific protocols were integrated with the traditional quality approaches and further scientific studies are still required to improve its quality.
authors: Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns Campus, Townsville, QLD, 4870, Australia. phurpaw@yahoo.com.
authors: Phurpa
authors: http://orcid.org/0000-0002-4381-7382
authors: P
authors: Wangchuk
authors: Menjong Sorig Pharmaceuticals, Ministry of Health, Thimphu, Bhutan.
authors: ᅟ
authors: ᅟ
authors: Tashi
mesh_terms: D001631:Bhutan; D004501:Education, Medical / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008518:Medicine, East Asian Traditional / Q000592:standards*; D011785:Quality Assurance, Health Care; D014495:Universities
keywords: Bhutanese So-wa-rig-pa medicine; Integrated health care services; Menjong sorig pharmaceuticals; Quality assurance system; Quality control parameter; Traditional medical education; Traditional medicine hospital