Cases of common cold and diarrhoea, the leading causes of morbidity in Bhutan, has seen a significant drop this year. This is a success story we all should cherish. Without a study done to ascertain the reasons for the success, some are quick to attribute the reason to the behavioural change forced by the coronavirus pandemic.

It could be one of the many reasons as personal hygiene is directly related to common diseases like diarrhoea. However, like health officials said, it is because of a combination of several health initiatives. For decades, our leaders had prioritised health as an important sector. While ensuring basic health services should remain free, there has been a concerted effort on prevention and awareness programmes to control many diseases that could be easily contained. We are seeing the fruits of our leadership and the efforts put in the health sector.

Health and development cannot be separated. The development the country has gone through in the past few decades have bearing on the health of the people. It is not only the access to health facilities.  If access to clean drinking water or toilets made a difference, education made Bhutanese aware. In short, it signifies the success of our priorities identified decades ago.

Not long ago, diarrhoea was, for a long time, the top 10 hazardous diseases. Diarrhoea and dysentery, if we look back, was the third biggest cause of death in the country. The priorities have changed and we are witnessing an epidemiological transition. Today, rising non-communicable diseases have added to the health burden. The pressure is not only on health services or hospital beds, but the increasing cost from referrals and human suffering.

As we cherish the success in controlling common diseases like diarrhoea, we are grappling with hypertension, diabetes, cardio vascular diseases, cancer, injury, alcohol liver diseases and mental health problems, all of which have become common lifestyle diseases in Bhutan today.

Our problem is manifold. We have had the opportunity to see the devastation that the changing lifestyles and bad diets have caused everywhere but we are taking the same path. We have a kidu-based health care system where the state bears all the cost. But funds that could be spent improving national health are used for treating problems that could be avoided.

If the combination of several public health prevention programmes and awareness among the public helped us control diarrhoea or flu, the same programmes are not helping us contain NCDs. Today, the problem is not that we do not know. It is that what we are doing is not effective.

There is pressure on the health services. And we are hearing, over and over again, that our health services must be sustainable and that we must start paying for it. The Constitution guarantees free basic health services. There is a lot of debate on what “basic” means as the burden on health increases. Is a disease caused by excessive use of alcohol needing referral to a foreign country basic?

From the health problems we are treating, we have entered a new era where we treat diseases of the developed world. From the health management system we are still in the Kidu culture. How long could we afford? How sustainable will it be? Should we start paying for some services? The questions are many. As we celebrate an achievement and are faced by another challenge, we should start thinking.