WHO Representative, Dr Rui Paulo De Jesus speaks to Kuensel’s reporter Dechen Tshomo on the role and priorities of WHO in the country. Excerpts

What is the role of WHO country office in Bhutan?

WHO’s goal is to build a better, healthier future for the people of Bhutan. WHO staff work along with the Government of Bhutan and partners to ensure the highest attainable level of health for all people. Together, we strive to combat communicable and non-communicable diseases (NCDs). We also try to help mothers and children live a healthy life. WHO’s work in Bhutan is guided by WHO Country Cooperation Strategy (CCS) for Bhutan (2014 -2019). In this CCS, we identify a number of strategic priorities together with our main counterpart that is the Ministry of Health, taking into consideration the work of other developing partner including the sister agencies.

Achieving and sustaining universal health coverage through a revitalised primary health care approach; scaling up prevention, early detection, monitoring and treatment of NCDs and addressing their determinants through inter-sectoral collaboration; pursuing a health through the life course approach with focus on maternal, new born, child and adolescent health; prevention and control of priority communicable diseases, in particular neglected tropical, vector borne and vaccine preventable diseases, and achieve and sustain MDG 6 targets are the strategic priorities.

These priorities are translated into action through WHO collaborative programme budget, which are biennial in timeframe. WHO country office also aligns its work with WHO’s global and regional priorities that is 13thGeneral Programme of Work (2019 -2023), WHO director general’s priorities, and WHO regional director’s Flagship areas.

What, according to WHO is the biggest health challenge for Bhutan today?

When we talk about the challenge, we need to look at the health system of the country. The overall performance of the health system in the country can be measured by the health outcome. I can say that it’s up to the overall development pace.

You look at the good distribution of health infrastructure, facility, and workforce along with the diagnostic facilities. Health services in the country also has been facilitated and benefitted from the improved public infrastructure, for example roads, water and sanitation and also the achievement in other sectors such as education and agriculture.

Despite all these we still have quite a lot of challenges.  While the communicable disease remains a substantial burden, for instance TB, although WHO mentioned that Bhutan is a low burden country but if you look at the incidence rate as well as the proportion of MDR TB, it is challenging.

At the same time, NCDs are increasing. There are also other challenges like substance abuse, suicide, maternal and neo-natal health problems in the country. We also need to take into consideration that Bhutan is a country that is prone to various natural disasters.

Although rapid socioeconomic growth and development has made life relatively easier for its citizens, there is an emergence of issues like substance abuse and suicide or other mental health problems in the younger population.

If you look at hospital care and take into consideration the universal health coverage, district and general hospitals and the referral hospitals play a major role though BHUs also have some observation beds. Although there is a good network of secondary care facilities, there is a need to improve on the range of services, for equitable access to healthcare and to reduce the strain on the referral hospitals. At the tertiary level also there is a need to increase the range of services and specialised care. Specialised care in mental health, which is currently limited to the national referral hospital in Thimphu, needs to be expanded to primary levels. Other areas that need to be addressed are in rehabilitation, long-term care and family care.

There is also a need for us to focus on health in all policies and look into its implementation, as health sector cannot address all the challenges. We need to explore avenues beyond health sector for healthy funds.

If we look at the recent recommendation, the health finance in Bhutan is still far less than what is expected. There are two approaches that we can take here. Of course, we need to reach a certain level of health financing for the health sector through the government budget. The second approach is how we can make the budget in other ministries become healthy budget, which means we ensure that the other programmes take into consideration the health aspect. For example, when you construct a road, the health sector ensures that dust is reduced while carrying out the project. In low land areas, it should be made sure that there are no avenues for vectors and diseases to breed in the construction areas.

How is WHO helping in addressing public health issues in Bhutan?

WHO is an organisation of member states of which Bhutan is a member. WHO has priority programmes based on natural priority that is also commensurate with global and regional priorities. WHO provides strategic and critical support to strengthen the capacity of the health system in Bhutan.

Bhutan saw the last case of poliomyelitis in 1986 and was officially declared polio free in 2014 together with other member states in the region. Universal childhood immunisation was achieved in 1991. While goiter was a common feature in the past, it is a rarity now as iodine deficiency has been eliminated in 2003. All these have been possible due to appropriate investments in health infrastructure, human resource development and leadership.

The result of this cooperation are evident from many achievements and milestones reached in 2017 which include Bhutan becoming one of the first two countries in the WHO South-East Asia Region to eliminate measles before the regional target of 2020 and WHO director general’s award on World No Tobacco Day to Health Minister Tandin Wangchuk for the nation’s unique efforts to ban the production and sale of tobacco.

WHO facilitated a workshop on the requirements for the Bhutan Emergency Medical Team to be certified by WHO and initiated the registration process to enable Bhutan to assist other countries during an emergency.

What are WHO’s priorities? 

Based on the expressed need of the country, the ten priority areas were selected through a consultative process.

The 10 areas for collaboration are neglected tropical diseases; NCDs; mental health and substance abuse; disabilities and rehabilitation; reproductive, maternal, newborn, child and adolescent health; health and the environment; integrated people-centered services; access to medical products and strengthening regulatory capacity; health system information and evidence; and emergency risk management and crisis management.

These are identified prior to the implementation of the programme and the programme budget is for two years. During the implementation, the priority may change given the availability of technical expertise in the country, availability of funds from the government, and new commitment from other agencies including the developing partners.

What are the areas of collaboration between WHO and Bhutan in the 12th Plan?

Our CCS is going to expire next year. I would prefer to extend it for another year because I see that the strategic priority is still relevant for another year.  After the finalisation of the 12th Plan, we can adjust, adopt and provide proper technical support for the achievement of the goals. WHO will continue to support Bhutan to attain and achieve various targets.