Health: To outline a feasible way forward for Bhutan in relation to the three major public health programmes: HIV/AIDS, Tuberculosis and Malaria, a two-day workshop in Thimphu began yesterday.

During the workshop, titled “Transition readiness financing for health: HIV/AIDS, Tuberculosis and malaria”, participants deliberated extensively on how to ensure that future collaboration with the Global Fund is sustained.

Global Fund is an international organisation designed to accelerate the end of AIDS, Tuberculosis and malaria as epidemics.

Founded in 2002, Global Fund is a partnership between governments, civil society, private sector and people affected by the diseases. Global Fund raises and invests nearly USD 4 billion annually to support programmes run by local experts in countries and communities most in need.

Health secretary Dasho Dr Dorji Wangchuck, said with the support from Global Fund to Bhutan, the funding gap has been significantly bridged for the three diseases since 2005 in relation to the Millennium Development Goals.

“However, there are new targets to be fulfilled, particularly the Sustainable Development Goals. The workshop aims to deliberate and look for mechanism on how to sustain the gains achieved in the three diseases through our collaboration with Global Fund and also prepare for a smooth transition to the next phase,” Dr Dorji Wangchuck said.

With Bhutan no longer in the least development country status, many donor agencies have started phasing out. Bhutan is now categorised in the pre-elimination phase from the Global Fund as well.

Global Fund has assured us that we are still eligible for grants after the New Funding Model grant of the Global Fund, which ends in 2018, Dr Dorji Wangchuck said.

“One option we are looking into is the Bhutan Health Trust Fund (BHTF) as an alternate finance mechanism. We are looking into an option of co-financing with BHTF as a strategic investment towards programmatic and financial sustainability for these public health programmes,” Dr Dorji Wangchuck said.

Global Fund’s Chief Economist, Dr Michael Borowitz, said Bhutan is still eligible for Global Fund’s grant for the next decade.

“Eligibility is not just based on a country’s total income but also on government’s spending on health and the country’s burden of diseases. Bhutan has a large public funding system on health. An allocation of fund also depends on how much fund we are able to collect. However, it’s the right time to plan ahead,” Dr Michael Borowitz said.

Until June 2016, Global Fund has allocated more than USD 13M to the three public health programmes in the country. About USD 4.1M has been allocated for HIV/AIDS, about USD 3.6M for Tuberculosis and about USD 5.4M for malaria so far.

Global Fund, Bhutan’s fund portfolio manager, Cristina Riboni, said most of the funds were allocated in travel related cost followed by procurement of pharmaceutical products and minimum in human resource in Bhutan.

“Significant achievements had also been made where Bhutan has one of the least prevalence of HIV cases. Tuberculosis has a high treatment success of above 90 percent and malaria has been almost phased out,” Cristina Riboni said.

About 160 people with HIV/AIDS are currently on antiretroviral therapy, 4,200 Tuberculosis cases have been detected and treated, and 362,000 insecticide-treated nets distributed.

Challenges such as limited records of national AIDS spending remains followed by conducting discussions to find ways to tackle the porous border, which is one of the main modes of transmissions of AIDS were also highlighted, among others.

Health ministry’s senior planning officer, Jayendra Sharma, highlighted the challenges of financing and sustaining healthcare system for the upcoming 12th Plan.

Today, non-communicable diseases and injuries are among the top 10 of the country’s health burden. More than 15 percent of the total recurrent cost is allocated for referral cases abroad, Jayendra Sharma said.

“Without a proper fund allocated, these will have a significant implication in the future in terms of health financing for the country,” Jayendra Sharma said. “Even the support from development partners and assistance are also going down – from 30 percent in the 90s to 12 percent today – a steady decline in external resources. It is important for us to look into innovative mechanisms such as the BHTF.”

BHTF’s director, Dr Sonam Phuntsho, said BHTF is an alternate finance mechanism to eliminate financing uncertainties for the core components of primary health care and reduce burden on government.

“BHTF could be a mechanism to finance sustainability for the public health programmes in the coming years. We are looking for ways for donors to allocate certain percentage of the project and programme budget into BHTF so that over a period of time, it can sustain the project and programme,” Dr Sonam Phuntsho said. “The health of the nation rests on the success of BHTF and we have the opportunity to make it happen.”

For now, BHTF is looking into ways of delinking from the government, re-engaging with past donors and increasing advocacy and resource mobilisation.

BHTF was launched at WHO head quarters in Geneva on May 12, 1998. Today, BHTF has achieved its target capital of USD 24M, which was achieved in 2009.

Thinley Zangmo