Healthcare in Bhutan

The Ministry of Health began to introduce a unified health system starting in the 1970s.

Healthcare facilities

In 2009, there were 31 hospitals throughout Bhutan. Most of the Dzongkhag had at least one hospital, with the exception of Gus . There were 5 hospitals in Thimphu , while in the Dzongkhagi Chukha , Samtsa and Trashigang - three each. In addition, each dzongkhag had a number of smaller medical institutions ^[1] .

3756 employees of the Ministry of Health worked in hospitals and other medical institutions: 176 doctors, 556 nurses, 92 assistant nurses; 505 health workers, 35 sanitary doctors and their assistants, 41 drungtshos (traditional medicine doctor), 52 smenpas (traditional medicine doctor), 12 pharmacists, 79 pharmacy workers, 13 laboratory technologists; 549 other specialists and assistants, as well as 1601 administrative staff and support staff ^[1] .

As of 2009, most Bhutanese had access to drinking water (83%) and basic sanitation (91%). The most common diseases were diarrhea (2892 per 10,000 people) and pneumonia (1031) among children under 5 years old; skin infections (1322); conjunctivitis (542), hypertension (310) and intestinal worms (170). Less common diseases were diabetes (38 per 10,000 people); alcohol-related liver diseases (23), as well as cancer (17). The incidence of malaria and tuberculosis is usually low, 10 and 15 cases per 10,000 people, respectively ^[1] .

In Bhutan, H1N1 (“swine flu”) and H5N1 (“bird flu”) strains have been reported. In 2009, there were 6 confirmed cases of the disease with H1N1 strain, none of which were fatal. However, there has been at least one outbreak of avian influenza in Gevong Phongcholing , and the disease is a matter of serious concern to the Ministry of Health ^[1] .

As of 2010, 185 cases of HIV were recorded. The Ministry of Health links the increase in diseases with licentiousness, drug use and the spread of HIV / AIDS in neighboring countries ^[1] .

Maternal and Child

In June 2011, the ONN Population Fund published a report on the state of obstetrics in the world ^[2] . It contains data on obstetric care, newborn policies and maternal mortality in 58 countries. In 2011, in Bhutan, maternal mortality was 200 cases per 100,000 births. In 2008, this figure was 254.9, and in 1990 - 1145.4 deaths. The mortality rate for newborns is 81 deaths per 1000 newborns. In Bhutan, the number of obstetricians per 1000 live births is 15. As of 2008, 90% of the population was covered by the government immunization program ^[1] . In 2010, the Ministry of Health noted a trend toward an increase in the number of clandestine abortions among Bhutanese women (466 in 2003; 1,057 in 2009) that seem to be performed in neighboring India , which contributes to an increase in maternal mortality in Bhutan ^[1] .

Food Quality

According to the 2005 Food Act of 2005 , Bhutan created a national commission for food quality control, headed by the Minister of Agriculture and comprising ten members from other ministries and departments (health, trade, home affairs, environmental protection) ) ^[3] . The Commission formulates the government's food policy. Food law also regulates food imports and exports ^[3] .

Smoking

The government of Bhutan has been actively promoting smoking cessation and sale of tobacco products using educational, economic and criminal incentives. In 2010, the Tobacco Control Act of Bhutan 2010 was enacted , which prohibits the sale of tobacco and imposes an import tax ^[4] . The law also authorizes the Council against Smoking to provide rehabilitation centers for the diagnosis and treatment of tobacco dependence ^[4] .

Alcohol

Bhutan also seeks to discourage alcohol consumption due to its effects on health and happiness. In 2011, the government adopted a decree on alcohol control, which, according to which the alcohol tax was tripled. As a result, alcohol sales fell and prices rose ^[5] . Recently, alcohol consumption among students has increased, as a result of which several of them were expelled from the elite Bhutanese college of Sherubze ^[6] .

Bhutan’s health care began to accelerate in the 1960s following the establishment of the Department of Health and the opening of new hospitals and dispensaries throughout the country. In the early 1990s, there were 29 hospitals in the country (including 5 leper colony, 3 army hospitals and one mobile hospital), 46 dispensaries, 67 medical centers and 15 anti-malarial centers. Large hospitals were in Thimphu , Gelephu and Trashigang . The number of hospital beds in 1988 was 932. There was an acute shortage of medical personnel. According to official statistics, there were only 142 doctors and 678 paramedics, about one medical specialist for every 2,000 people, or only one doctor for almost 10,000 people.

The Royal Medical Institute, together with the National Hospital , established in 1974, organized courses for orderlies, nurses and midwives. Graduates of the courses became the basis of the national health care system and assisted health workers throughout the country. Volunteers from villages were recruited as assistants to them ^[7] .

Treatment in Bhutan is free; the government finances the universal health system. However, there are few hospitals in Bhutan, and some diseases, such as cancer, are not treated in Bhutan. Patients who cannot be cured in Bhutan are taken to hospitals in India, and their treatment is paid for by the government of Bhutan ^[7] .

In the 1980s, the most common diseases in Bhutan were gastrointestinal infections, mainly due to a lack of clean drinking water. Respiratory diseases, diarrhea and dysentery , helminths , skin infections , malaria , malnutrition, and conjunctivitis were also common. In 1977, the World Health Organization (WHO) declared Bhutan a smallpox free zone. In 1979, a nationwide immunization program was established. In 1987, the government, with WHO support, developed a program to immunize all children from diphtheria , pertussis , tetanus , polio , tuberculosis, and measles by 1990. By 2000, the government planned to eliminate diseases such as diarrhea, dysentery, malaria, tuberculosis, pneumonia and goiter . In the 1970-1980s, progress was made in the treatment of leprosy , during these years the number of patients decreased by more than half, and in 1988 the government planned to defeat the disease by 2000 ^[7] .

It is estimated that in 1988 only 8 out of 1,000 people had access to clean drinking water. Despite the improvements provided to people through government economic development programs, Bhutan still faces health problems. Among the factors determining the high morbidity in the country and mortality, one can single out the harsh climate, poor sanitary and hygienic living conditions, for example, dwellings not ventilated in winter, which contributes to the high incidence of leprosy, and the inhalation of smoke during cooking due to poorly ventilated equipment. However, in 1980, it was estimated that 90% of Bhutanese daily consume enough calories.

Although there were no reports of AIDS cases until the early 1990s, the Department of Health established a public awareness program in 1987. With the support of WHO, a “referral laboratory” was established at Thimphu Hospital, which tested for AIDS and HIV. In 1990, representatives of the National Institute for Family Health were sent to Bangladesh for training in the prevention and treatment of AIDS ^[7] .

• Official website of the Ministry of Health of Bhutan . Date of treatment July 13, 2011. Archived on May 14, 2012.
• Bhutan . World Health Organization. Date of treatment May 17, 2014.