The health ministry has proposed a budget of about Nu 4.02B (Billion) for the 12th Plan but the allocation is still in negotiation with the Gross National Happiness Commission (GNHC), which has allocated Nu 3.62B.

Health minister Dechen Wangmo, at the first meet the press session yesterday, said this in response to a question on the tentative budget allocated for the health sector in the 12th Plan.

In the 11th Plan, Lyonpo said the allocation was about Nu 5B with the absorption of almost 76 percent. “So it was coming to about Nu 4.12B and our revised proposal to GNHC to around Nu 4.02B. We are still in discussion.”

Lyonpo said that as of now, the ministry is looking at about Nu 2.6B with a little more than Nu 1B as capital budget and about Nu 1.12B as spillover from the 11th Plan. “That gives us Nu 2B allocation to work with.”

“The allocation of health budget as a proportion of GDP is around 3.7 percent as of 2016,” Lyonpo said. “What we are advocating for is above five percent.”

Bhutan’s spending on health has declined over the years. From 5.7 percent of GDP spent on health in 2000, spending on health dropped to 4.9 percent in 2003, and 4 percent in 2006.  It further dropped to 3.65 percent in 2010, and to 3.55 percent in 2012.

For the fiscal year 2014-15, the spending on health was 4 percent, which dropped to 3.9 percent in 2015-16.

“If you really want to transition from basic health services to quality and comprehensive health services, we should definitely have and look forward to having a bigger fiscal space for health,” Lyonpo said. “Our idea is that we really want to provide quality and comprehensive services to our people and that is what we are negotiating at the moment with the GNHC.”

Health secretary Dr Ugen Dophu, during a high-level advocacy event for parliamentarians and key stakeholders for accelerating prevention and control of NCDs in Thimphu last week, said that Bhutan needs to spend a certain percentage of its budget on disease prevention and health promotion.

“Unless Bhutan spends a certain percent of our budget on this, we will be overwhelmed one day by just spending money on curative care,” Dr Ugen Dophu said.

He said the health ministry faces many challenges in providing free health care to the people. “Although we have come a long way in controlling communicable diseases, non-communicable diseases due to change in lifestyle and dietary style leads to increased cost in health care expenditure.”

Dr Ugen Dophu said that to treat a diarrheal case, health ministry can manage within Nu 200 but to treat a hypertension case, the cost for one patient for a visit is about Nu 600. “In order to treat patients with diabetes, hypertension or kidney failure and keep these group of patients alive for many years, the cost to the government coffer is rising every year.”

He said it costs the ministry huge money to introduce new technologies and new services, and also the people’s expectation from the public health system has increased. “People expect five-star kind of services from health which in the public health system is quite difficult with resource constraint.”

He said Bhutan is graduating to become a lower middle-income country and donors have already started withdrawing so it is a huge challenge for the health ministry. “This downward trend of GDP expenditure on health is not good for all Bhutanese.”

Prime Minister Dr Lotay Tshering said Bhutan has always been proud of its free health care services to its people.

“But, on the flip side, we have always had about 3.5 and 3.4 percent, not even 4 percent of the GDP as health budget,” lyonchhen said. “If we look at these two together, we never had enough budget – meaning, for a very less proportion of the budget that is spent on health, we are giving everything free, which clearly show that we actually do not have good quality health care.”

From a health economics point of view, lyonchhen said that spending very less and providing everything free means the health care system is not good. 

“We have done enough and very well on primary health care. Now we are embarking into tertiary health care,” the prime minister said. “Currently, we do not have a hospital that qualifies as an international tertiary level health care. As we embark on it, the sector would need more fund.”

Lyonpo Dechen Wangmo said the ministry is happy to report that it might have, after going through the scrutiny of the government, a flagship programme for health. “A team, at the moment is working on the flagship and if it gets through then we would have a flagship for health.”

Dechen Tshomo