Bhutan has made remarkable progress in socioeconomic development including health over the last five and a half decades.
This is one of the key findings of the Bhutan Health Systems Review (HiT) that health minister Tandin Wangchuk launched at the Le Meridien in Thimphu yesterday.
Lead author of the HiT and former health secretary, Dr Sangay Thinley during his presentation on HiT, said the 2015 triennial review found Bhutan eligible for graduation from a least developed country to a lower middle income country for the first time by fulfilling the gross national income and human development index criterion. “Only the economic vulnerability index is to be fulfilled.”
The development philosophy underpinned by Gross National Happiness and its operationalisation through systematic planning and monitoring process has ensured a definitive improvement in the happiness and satisfaction of the people rather than mere growth of GDP, Dr Sangay Thinley said.
“The most outstanding achievement is the reduction of extreme poverty measured by USD 1.90 a day income to just two percent of the population in 2012, almost achieving poverty elimination,” he said.
Some of the other key findings are that a good balance between primary, secondary and tertiary care level health facilities need to be developed and capacity to generate evidence as well as translate them into policy and practice is an area that needs focus.
Dr Sangay Thinley said this is particularly relevant for the national referral hospital.
Despite the difficult geographical terrain and dispersed population settlements, access to health services has improved remarkably, Dr Sangay Thinley said. “Bhutan has achieved full geographical coverage of Basic Health Unit (BHU) I and II, district hospitals and referral hospitals. Today, about 95 percent of the population lives within three hours by any means of travel from a nearest health facility.”
While health systems reviews were conducted earlier, this is the first comprehensive, globally standardised review of Bhutan’s health system ever conducted.
The review report, which was initiated a year ago, was based on the standard template of Asia Pacific Observatory for Health Systems and Policies (APO), written by a national team and edited and reviewed by international experts.
The APO is a joint venture of interested governments, international agencies, foundations, and researchers that advocates evidence-informed health system policy regionally and in all countries in the Asia Pacific region.
Lyonpo Tandin Wangchuk said he is pleased to inform the people that the review has identified and documented lot of encouraging aspects of the country’s health system. “The launch of this report is timely as we are now developing the country’s next five year plan. The findings of this report will serve as a very important baseline reference for planning and designing appropriate interventions.”
Lyonpo urged all stakeholders to consider inputs from the review while formulating plans and policies.
During the first five-year plan there were just two hospitals and 11 dispensaries in the country. Today, Lyonpo said the population live within the access of three hours to the nearest health facility. In 1954, there was only one doctor and the country now has 299 doctors.
Lyonpo said the ministry is aiming towards self-reliance in terms of health workforce particularly nurses. However, there is a need to continuously invest in strengthening health human resource according to the health minister, which he considers as one of the most important pillars of health systems.
He said the ministry is on track towards achieving Universal Health Coverage with 100 percent of population covered, and significant level of financial protection maintained with out of pocket expenditure at 12 percent of the total health expenditure excluding transportation cost.
The significant improvements in health outcomes he said are clearly, the result of the providing free access to comprehensive services, support and commitment of individuals involved in delivering health services.
Health secretary, Dr Ugen Dophu, said it is encouraging to take note that Bhutan’s health system has progressed over the years. “However, we also need to be mindful of health system gaps that need to be strengthened as we move towards the realisation of the sustainable development goals and maximising Gross National Happiness.”
Dechen Tshomo and Rinchen Zangmo