Accelerating mother and child health to cost Nu 238M annually 

At the existing daily wage rate, implementing the programme to accelerate mother and child health in the country would cost the government about Nu 238.97 million annually.

In one plan period, the budget requirement is estimated at Nu 1.195 billion.

Health Minister Dechen Wangmo said the ministry is exploring with its partners for funding.

The health ministry is expected to roll out the programme called Accelerating Mother and Child Health – 1,000 Day Plus by August this year. The programme’s main objective is to safeguard the health of vulnerable pregnant women and mothers who have recently given birth or are breastfeeding, as well as that of the infants through the coverage of quality maternal and child health services.

The system would be applicable for all pregnant women, but the target for the conditional cash transfer (CCT) will include only those mothers who are not entitled to six months paid maternity leave. This includes those mothers in the private and corporate sectors.

They would be paid the national minimum wage of Nu 125 a day. On an average, 11,000 babies are born annually in the country today.

Should the government fulfil its pledge to revise the minimum daily wage from Nu 125 to Nu 450, then the required budget for the programme would double. However, it is not yet known if the allowance would be revised with the revision of the minimum daily wage.

The CCT will be disbursed in four disbursement periods after the fulfilment of the defined criteria by the eligible mothers.

Completing the recommended eight ANC visits and four post-natal check-ups, institutional delivery, and completions of immunisation schedule and exclusively breastfeeding for six months are some of the criteria.

To accelerate the improvements in maternal and child health, Lyonpo said that optimum utilisation of health services has been identified as one of the key strategies.

“Demand-side programming that looks at providing incentives to avail the necessary health services have been known to work in many settings,” she said. “We have to be pro-active. If we say we have the services then nothing will happen.”

Lyonpo said that a CCT that provides certain monetary incentives for mothers in Bhutan who avail the requisite maternity and child health services will accelerate the outcomes for maternal and child health.

With the introduction of CCT, the ANC minimum eight visits are expected to significantly increase from 26 percent as of 2015. It would also promote institutional delivery while at the same time referral can also be facilitated should obstetric complications arise.

Lyonpo said that while institutional delivery was always encouraged, sometimes people don’t have the resources. In this modal, health assistants will facilitate an ambulance for the woman to deliver the baby in a hospital. “We will put the responsibility on the health workers.”

She said there would be few who would not be able to deliver in a hospital because of various circumstances. “We are not saying that if they don’t go and deliver in an institution then we will not give the money. It’s an opportunity for us to learn and see what are the barriers and give us an opportunity to strengthen and improve our system.”

The postnatal period is a critical phase for the lives of mothers and newborn babies as most of the maternal and infant deaths occur during the period. At least three additional postnatal contacts are recommended for all mothers and newborns, on day 3 (48 -72 hours), between days seven to 14 after birth, and six weeks after birth.

It is also expected to maintain high immunisation coverage and exclusive breastfeeding for six months. Lyonpo said that the country was never reaching 100 percent. “With this, we will reach 100 percent.”

Only about 51.4 percent of women reported exclusive breastfeeding their children in 2015. About 21.2 percent of the children aged 0 to 59 months were stunted, 4.3 percent wasted and 9 percent underweight.

For the CCT, a mother needs to have a saving account. The money will be transferred into the mother’s saving account. “That way, we economically empower our women.”

Today, Lyonpo said that women who don’t work don’t think about getting a savings account. “The moment she opens an account, she will know how the banking system works and then she knows how to use the ATM and, in these small pieces, we empower women.”

People raised concerns when the DNT government pledged that they would provide breastfeeding allowance. Lyonpo said DNT would be giving money to mothers for breastfeeding the baby.

“That was never our vision. Our vision was to take care of the future and take care of the pregnant mother with the value that raising a child is a national responsibility,” she said.

Lyonpo said that human capital is important because it is the engine and driver of the economy and it starts from conception. “We look at it as a national investment for future so that we have a strong, healthy generation to shoulder the responsibility of nation-building,” she said. “We hope that whoever comes next will continue this.”

Dechen Tshomo

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