Bhutan: Bhutan Health Profile 2012
2012/02/22
Bhutan Health Profile 2012
Health policies and strategies
The Royal Government gives great importance to the social sectors- especially education and health. The Government pursues a policy of providing essential health care services free of charge.
In order to sustain achievements in Primary Health Care and reduce the dependency on donors, the Royal Government has initiated the creation of a Health Trust Fund. The total capital for the Health Trust Fund has been initially set at US $ 24 million. As per the Royal Charter of the Health Trust Fund, the Royal Government will match, on a one-to-one basis, any donor contribution to the Fund. The fund will be maintained in US dollars and invested in reliable financial institutions abroad. It will be governed by the Management Board consisting of high-level members representatives from the relevant Ministries and organizations.
This initiative is expected to support the Royal Government's policy of providing free essential health care.
For the purpose of maintaining quality of health care service and protecting the qualified human resource for health, private practice has never been introduced.
As the traditional medicine practiced in Bhutan, Sowa Rigpa, is a systematic field of knowledge, traditional medical care is provided side by side with modern allopathic health care. These two systems are now more or less integrated.
Within the overall long-term objective of the Health Ministry, "attaining a healthy living standard by the people living within the broader framework of the overall development of the country", there has been a shift from expansion of services which was emphasized in the earlier plans to the quality of services which entails setting up of standards at various levels of health care delivery system. Strategies have been developed to reach the un-reached through decentralization of planning and management systems; to strengthen management information system, to develop research and their use which leads logically to one of the Ministry's most important objectives: intensifying human resource development for health and establishing a system of continuing education. To this end, the Ministry has developed the Master Plan for Human Resource as a guide for developing human resource for health.
Intensification of prevention and control of prevailing health problems and dealing with the emerging and re-emerging ones require extra resources and effort and the Ministry has prepared itself in dealing with this problem. Other objectives that have flowed from the past plans are intensification of reproductive health services and sustaining population planning activities; promoting community-based rehabilitation, mental health, and finding innovative means to enhance the mental well-being of the people; and maintaining balance between primary, secondary, and tertiary health care so that the higher levels of service can back up the needs created or problems identified by the lower ones.
With the intentions on health coverage, the Royal Government has not been able to give a legal framework for medical services both to protect the medical practitioners and the patients. Now the Bhutan Medical and Health Council Act has been passed by the National Assembly in 2002. Further, the Medicines Act is being drawn up to regulate the sell of the medicines, drugs and other substances in the country.
Managerial process
The Ministry of Health and Education is headed by a Minister. A Secretary looks after both the Health and Education affairs at policy level. The Health Department is headed by a Director. Please see the organogram in Annexure.
The health services in the districts are directly under the administration of the Dzongdag, district magistrate. The Health Department provides technical support to the districts. District Medical Officers look after the hospitals and District Supervisory Officers look after the primary health care concerns in the districts. The Basic Health Units at the community level are directly under the administration of the District Health Supervisory Officers.
However, in line with good governance policy, the Royal Government has now decided to restructure the Ministry of Health and Education into two separate Ministries.
Organization of the health system
The basis for Bhutan's health care delivery system is the primary health care system starting with the 445 outreach clinics and 163 basic health units at the community levels. The districts have the district hospitals organized under the three Regional Referral Hospitals and one of these Regional Referral Hospitals also serve as the National Referral Hospital.
Patients at the basic health unit level are referred to their respective district hospitals for secondary or tertiary health care. The district hospitals likewise refer to their respective Regional Referral Hospitals and that in turn rely on the National Referral Hospital. As it is not yet possible to have very specialized health care in the country, a good number of cases requiring such health care are referred outside the country.
The healh service system at the district and lower levels depend on the district authorities for their administrative support and on the Health Department at the centre for technical support. The basic health units submit their case reports directly to the District Supervisory Officers who compiles them and submit to the Health Department at the national level. However, the diseases under strict surveillance like HIV, Poliomyelitis, etc. that come under the notifiable category are reported directly to the national level immediately.
Community participation
In order to bridge the gap between the organized health service and the community, the Government trains village health workers who are chosen by the communities themselves. As of 2000, there are 1,327 village health workers who advocate health to the people and who help in bringing the health problem of the people in the communities to the health workers. They are also taught and allowed to dispense a few basic allopathic medicines.
The communities also look after the development schemes like those for drinking water supplies in their own areas. The programme assists the communities by providing them the required training.
Then there are the traditional faith healers, astrologers and religious leaders in the communities. The Ministry also takes the support of these respected people in imparting specific health messages -ranging from the need to take iodized salt to family planning - to the people in the communities along with their routine work.
Health information system
Realizing the importance of information in management, Health Information Unit was established in 1983. Since then the Annual Health Bulletin was compiled on a yearly basis and published. WHO has put in substantial support to develop the Health Information System in the 1990s. During 1999-2000, the information system was reviewed and the Health Information Management System was instituted with support from DANIDA. Presently HMIS is being computerized and experimented.
The basic health facilities have been given standardized reporting forms to report the morbidity, mortality and other health data collected at that level. This is compiled and consolidated every month and submitted to the District Health Supervisory Officers who, in turn, compiles and submits to the national level every quarter. At the national level the Health Information Unit compiles and makes it available to all concerned.
However, the human resource for the Health Information Unit has to be further improved both in terms of expertise and number to make the Health Information System dynamic and helpful for evidence-based planning for the future.
Inter-sectoral coordination
Intersectoral coordination at different levels of the Government is achieved through different ways. At the national level, the Planning Commission coordinates the plans of various development sectors and the Department of Aid and Debt Management of the Ministry of Finance coordinates resource allocation. At the district level, when the plans are implemented, the Dzongdag is the overall head. All the sector representatives at the district level function under the Dzongdag. Thus duplication of efforts is avoided and the actions are coordinated.
Even at the Department and programme level, there are a lot of coordination mechanisms through Policy and Planning Division of the Ministries. Additionally, individual programmes have their own coordination mechanism with other concerned sectors. Malaria programme, for instance, has direct coordination mechanism with the agriculture and municipal departments. Similarly environmental health programme liaises with the National Environment Commission, Municipal Corporations of each district and even the police force. The nutrition coordinates its efforts with the Agriculture, Trade, and other relevant sectors. Further, there are the multi-sectoral task forces that also address the issues that cut across many sectors.
Emergency preparedness
Of the numerous emergency situations, the one that concerns the country most is the traffic accidents. Flash floods and landslides also contribute to the problem. The country being in an earthquake zone, severe earthquake is also read about in its history but it is less frequent. Glacial flood also cause damage to the life and property. A rough study in the recent years revealed numerous glacial lakes that are potentially dangerous to the country. Further, of late the presence of the militants from across the southern border poses an enormous threat to the national peace and security.
In order to deal with all these eventualities, the Ministry of Health and Education has established a rapid response team consisting of several relevant sectors. An emergency medical team further backs this establishment.
Health research
Health research is comparatively new for Bhutan although Bhutan has been a participant to WHO's research consultations in Region. To be able to carry out research for the health sector so that there will be evidence-based health interventions; the country has been building its research unit. The Research Unit was formally established in 1995. The key staffs are still being trained abroad. The unit has played crucial roles in conducting vital studies for health in the recent years. It has contributed in the conducting of the National Health Survey in 2000 and in carrying out the survey on mental health in 2002.
Coming to the area of other kinds of research, the Pharmaceutical and Research Unit at the National Institute of Traditional Medicines conduct research related to indigenous medicines. Further it is also documenting the medicinal plants and herbs that are found in Bhutan.
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