While the health ministry does not have any risk indicators, Prime Minister Tshering Tobgay pointed out during the mid year review that infant and under-five mortality and maternal mortality were not mentioned in the ministry’s annual performance agreement (APA) 2017-2018.

Lyonchhen said infant mortality is one of the indicators at risk in dzongkhags. “It will be at risk because the target was set at zero. If it could be achieved, then good but this defies all international standards.”

Every country reports infant mortality, Lyonchhen added. “We can’t have infant mortality at zero.”

Lyonchhen clarified that the number of infant mortality are not high. “It is just that the dzongkhags have the target at zero in their APA and when few infant mortality cases are reported, they have put the indicators at risk.”

“If we look at the health ministry’s APA, infant and under-five mortality and maternal mortality were not mentioned. It means that these are lessons for the next year,” Prime Minister said. “We are doing a good job, way better than international average. We must continue to measure so that we continue to improve.”

Prime Minister said the health ministry ought to investigate why babies died in dzongkhags that reported high infant mortality. “Pemagatshel has availed helicopter services 13 times; 11 had to do with babies. All 11 babies survived,” he said. “Small interventions will have huge impact for our children, for the future of Bhutan. So these are also targets that the health ministry should incorporate but, in the meantime, please do a study.”

During the mid-year review of APA of all dzongkhags and the four thromdes, lyonchhen said maternal mortality in the first six months was zero. “That is outstanding. It means every delivery is an institutional delivery.”

Some women who couldn’t give birth and who had complications after giving birth were airlifted to the referral hospitals and that also played a role, Lyonchhen said. “Regardless, the result is zero maternal mortality.”

An official with the health ministry’s Policy and Planning Division said the infant and under five mortality and maternal mortality are not mentioned in the ministry’s APA 2017 – 18 because it is statistically not appropriate. “Given the country’s population, it is difficult to calculate the mortality rate or ratio for a year according to WHO’s standard,” the official said.

However, the official said that dzongkhags record the incidence of headcount. “At the end of five years, we can have a cumulative figure of annual incidences of each dzongkhag. That time we will have room to apply the statistics.”

Considering the importance of infant mortality rate, under-five mortality and maternal mortality rate, the official said that it is included in the 12th Plan.

Meanwhile, of the 39 success indicators, the health ministry has achieved eight and the rest are on track. Health ministry is one of the three ministries that do not have any risk indicators.

The ministry targeted to have at least three doctors in all dzongkhags and to increase nurse-to-bed ratio to 1:6 from 1:7, to strengthen diagnostic, curative, and palliative healthcare services.

Except for Gasa, all dzongkhags have at least three doctors. Nurse-to-bed ratio has also increased to 1:6.

Director general of the medical services department and officiating health secretary, Dr Pandup Tshering, said that in terms of population and the size of the Basic Health Unit, two doctors are adequate for Gasa.

To improve preventive, promotive, and rehabilitative healthcare services, the ministry targeted 80 percent of rural households with access to improved sanitation. According to the Bhutan Living Standards Survey (BLSS) 2017, about 88 percent of the rural households have the access.

Prime Minister Tshering Tobgay said building toilets is important, but using it is more important. “People are disgusted by feaces, but they are not aware of the infectious diseases that will be caused by it. So, it is important to educate people on the risk from exposure to human feces.”

“Achieving 88 percent of the target is good. Perhaps 80 was too conservative a target since we reached 88 in six months,” the Prime Minister said. “There are five more months and we can achieve more than 90 percent.”

The prime minister also pointed out the lack of proper data. “We are still compiling them so, the target we set maybe too high or low. We will be able to establish meaningful and realistic targets when we get a right baseline.”

The target to have three hospitals providing adolescent-and youth-friendly health services is claimed as achieved with services available in Trongsa, Samtse, and Samdrupjongkhar.

The ministry’s institutional delivery target of 87 percent has also been achieved. It is today 93.6 percent according to BLSS 2017.

Prime Minister commended the achievement. “Let’s see how we can achieve more in the remaining six months. Let’s go all out to make sure that all our women are delivering their children in hospitals.”

The ministry has also finalised the General Health Impact Assessment Guideline since November last year, as per the target. Dr Pandup Tshering said the guideline was put up in the high level committee with the ministry and approved.

The ministry met the targets to launch the National Health Accounts study by October last year and finalise the draft 12th Five-Year Plan (FYP) for the health sector by December.

Health ministry’s expenditure in the last six months was 34.06 percent amounting to Nu 856.74M. Of this, Nu 489.86M was current expenditure.

Speaking on the importance of having a female health assistant in BHUs, the Prime Minister said that while he understands the difficulties female health workers face when posted to BHUs, it is also important to know that for women, it is more important to have a female health worker to help them. “We have to try our best because the lives of our women are at stake.”

Pregnant women have to visit health centres for antenatal care and women are not comfortable when the health worker is a male. “This is linked to maternal mortality and infant mortality,” he said.

Dechen Tshomo