Community action was found to be effective in bringing positive impacts in reducing the harmful use of alcohol.
This is according to a pilot study conducted by Mental Health Programme in 2017 in Toetsho gewog, Trashiyangtse to evaluate effectiveness of community based intervention to reduce harmful use of alcohol in rural communities.
The study involved one intervention and one control community. The interventions were developed and implemented in consultation with the community by empowering them for monitoring to ensure the effectiveness of the intervention.
The study states that the objectives and benefits of community action were discussed with Toetsho gewog administration and they agreed to support the initiative. “There has been good cooperation from the community as well as the group who are responsible for monitoring.”
After the intervention, the study found that the practice of offering tshogchang decreased from about 99 percent to about 50 percent.
The practice of children drinking alcohol decreased by 6.83 percent. In terms of spending, it found that the average monthly spending on alcohol reduced from about Nu 418 to about Nu 97, and the amount of grains used for brewing decreased from about 34kgs to 18kgs.
One day facilitators’ training was organised with all tshogpas, three influential people from each chiwog and health assistants during which facilitators also drew an action plan including awareness programme, framing of bylaws and monitoring mechanism.
The bylaws include discouraging home brewing, alcohol use during religious rituals was replaced by soft drinks, disallowing sale of alcohol in grocery shops and communities started contributing a fixed amount instead of alcohol during bereavement.
The study states that a group was identified in the chiwog to monitor the bylaws. All community events like tshechus and religious rituals were monitored to reduce alcohol use and gewog administration restricted the unlicensed sale of industrial alcohol.
Due to budgetary and time constraint only one intervention and one control gewog were selected in the study. Also, the long-term impacts such as reduction in heavy episodic drinking and its related consequences were not assessed in the study.
Alcohol consumption is a major public health concern and harmful use of alcohol is causing undesirable consequences in the life of individuals, families and society.
The study states that the per capita alcohol consumption in Bhutan is higher than global consumption. “As per administrative data collected from the health centres, alcohol-related liver disease is the leading cause of death in the country.”
There were 190 deaths due to harmful use of alcohol in 2016 and alcohol liver disease incidence was 46 per 10,000 population.
“Apart from health, alcohol use poses threat to social harmony, loss in economy, aggravates suicide and increases crime,” it states.
According to reports, about 70 percent of domestic violence was attributed to alcohol use.
Considering the harmful use of alcohol, the government has initiated numerous strategies to reduce harmful use of alcohol in the country through its National Policy and Strategic Framework to Reduce Harmful use of Alcohol (2015 – 2020).
“One of the strategies is community action to reduce harmful use of alcohol in the communities,” it states. “WHO regards community action as one of the effective measures to deter alcohol use in communities.”
However, it states that there is no research-based evidence on the effectiveness of community action in Bhutan. “Therefore, this pilot study was conducted.”
The study recommends expansion of such community action in other communities in Bhutan with similar context. However, it states that the same intervention may not be applicable and may require to be contextualised.