In a sector not short of challenges, this dwindling of financial resources is its greatest

Budget: It was almost paradoxical that, just as healthcare professionals gathered to discuss keeping pace with scientific updates in medicine over the weekend, they received a chilling reminder that the health sector has been seeing budget cuts over the years.

This decline in health budget over the Plan periods, the director general of medical services department, Dr Ugen Dophu, said, was the biggest challenge facing the sector, which is already grappling with a shortage of medical professionals.

From 5.7 percent of gross domestic product spent on health in 2000, Bhutan’s spending on health over the years has declined to 3.5 percent today.

“This is the greatest challenge for all of us because, if expenditure on health is declining, then sustainability of health care and training of health care providers will not happen,” Dr Ugen Dophu said. “And we’re already noticing this happen.”

From 5.7 percent of GDP 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.

Dr Ugen Dophu said he was sharing this with practising medical professionals so that they were able to speak in the ‘same language with the politicians.’  This issue had been raised, he said, with both the former and present governments, but the ministry was told to manage with the allocated budget.

Among the countries in the region, Sri Lanka, after Bhutan, is the only one that spends 3.6 percent of its GDP on health. “Despite this, the good thing is that both Sri Lanka and Bhutan are still managing to deliver healthcare services to people efficiently,” he said.

According to the 11th Plan documents, the government health sector expenditure over the last ten years has averaged Nu 1.2B per annum, with an annual expenditure growth of 12.5 percent.  The government health expenditure as a percentage of GDP stands at 3.23 percent, it states, adding that the recurrent expenditure to GDP in the 11th Plan is projected to be around 0.56 percent.

The Plan documents state that expenditure in the health sector is expected to increase in the coming years, with the introduction of new technologies and services, and growing incidence of non-communicable diseases, for which the associated costs are much greater than for conventional diseases.

“We have to do a lot but we have no money,” Dr Ugen Dophu said. “The cost of essential drugs, which needs to be revised every two years, is always increasing, while the quantity of drugs we procure also increases annually.”

Health officials said there was a need to upgrade health facilities and introduce diagnostic services, such as X-ray and ultrasound services in BHU I, so that these services are accessible by all across the country.

“All these issues can be taken care if the spending on health increases to 5 percent of GDP,” Dr Ugen Dophu said. “The cut in budget impacts health directly, but it affects the whole country as well.”

The Constitution mandates the state to provide free health care, ensuring that global commitment to universal health coverage is achieved.  Currently, the government budget outlay for health is around 6 percent, and total health expenditure as percent of GDP is 3.6 percent.

“Global health experts recommend an allocation of around 5 percent of the GDP and about 8 percent of the total government spending on health for a country like Bhutan to ensure that quality health care services are provided,” the 11th Plan document states.

Delivered through a network of 758 health facilities with a workforce of 4,210 across the country, the health system in the country, at 88 percent, is predominantly government financed.

According to the National Health Accounts study, 2009/10, Bhutan’s per capita spending on health was Nu 2,847.  The study found that only about 11 percent of the total health expenditure is household out of pocket expenditure.

However, the budget isn’t the only challenge confronting the sector.  It’s already seeing impacts of climate change on health, with vector borne diseases emerging in non-endemic districts, and rural urban migration.

“Another challenge is the unreached population, such as the nomadic community and those in peri-urban areas,” Dr Ugen Dophu said. “As per the 2012 health survey, about 6 percent of the population is still unreached.”

Meanwhile, to sustain the health system, some doctors suggested outsourcing selected health services to private health care providers, while some said it was the management’s fault in not being able to convince the policymakers.

By Sonam Pelden