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Country Health Profiles

Political and Social-Economic Trends

Political Trends

Bhutan has graduated from an unknown country of feuding lords and clansmen into enlightened monarchy in 1907. Systematic modern development began during the reign of the Third King with the starting of the Five-Year development plans. By 1981, His Majesty King Jigme Singye Wangchuck initiated a vigorous programme of administrative and political decentralization. The decentralization policy has enhanced the democratic powers, social responsibilities, transparent processes, and structures of villages and communities to make decisions at the grass-roots level. The Government and its institutions are making every effort to serve the people with integrity, accountability and transparency, thereby bringing about good governance. As a result of the decentralization policy, the country has taken steady steps towards democracy with the establishment of Dzongkhag Yargay Tshogchungs (District Development Committee) in all its 20 Dzongkhags or districts and Gewog Yargay Tshogchungs (Block Development Committee) in the 201 gewogs or blocks.

The greatest change in the devolution of power took place in June 1998 when the King voluntarily handed down full executive powers to a Council of Ministers elected by the National Assembly. On 30 November 2001, the King took another bold and historic step by ordering the drafting of the county's constitution, as he firmly believed that "it is my duty, as the King, to strengthen the nation so that the people can develop in security and peace, and the national becomes more prosperous and secure than before". According to him, a democratic system is desirable for Bhutan as the principles and ideals of democracy are inherently good. Therefore the constitution must create a framework structure that will make democracy effective in Bhutan. "It must embody the expectations and aspirations of the people and draw on the wisdom of the existing system, the existing laws, and the lessons learned by other countries around the world."

The formulation of the Ninth Five-Year Plan showed that the decentralization process has ultimately reached the grass-roots level. The plans came up from the gewog (block) levels to the districts and then finally to concerned sectors at the national level. This is finally discussed and approved by the national assembly where the source of the plan, the people at the gewog level, are adequately represented again.

Economic Trends

The economy of the country steadily grew from 6.5% in 1997/98 to 7.3% by 2001/2002. With the commissioning of several mega-hydroelectric plants during the 9 th Five-Year Plan much more development is expected as electric power will not only bring revenues from sale but also help the industries sector in the country itself. However, given the country's delicate situation and small economy, provisions should be kept for emergencies. For instance, Bhutan is located in the Himalayan earthquake zone and heavy earthquakes have not been unheard of in its history. Glacial floods have damaged development structures in the near past. If GDP fell by 2 % in 2000/2001 because of disruptions from heavy monsoons, impact on economy due to damages to big hydroelectric plants that fill the major river systems will be devastating.

Bhutan National Human Development report for year 2000 puts Bhutan in the category of medium human development countries in the south-east Asia region along with Sri Lanka and Maldives with a human development indicator of 0.581 in 1998.

Demographic Trends

The population of the country was estimated to be 698,000 in the year 2000. The population is largely rural with 79 per cent of the population living in village despite a growth in the urban drift in the recent years. It is estimated that 42.1 per cent of the population is under the age of 15 years and 7.2 per cent above 60 years. While there are several language groups and communities, the country is essentially composed of two broad ethnic groups. The Drukpas who are of Mongoloid type ethnically are of Buddhist faith and constitute about 80 per cent of the population. The remaining people are of Nepali origin that are of Indo-Aryan and Hindu faith.

The crude birth rate during 2000 was 34.09 per 1000 population and crude death rate was 8.64 per 1000 population during 2000. Total fertility rate was 4.7 and there is a general decrease in the population growth rate from 3.1 in 1994 to 2.5 in 2002. The sex ratio of males per 100 females during 2001 is 102.

Social Trends

The education programme began during the First Five-Year Plan with the starting of a few Hindhi medium schools. Seeing that the English medium would have broader significance for Bhutan, the medium of instruction was quickly changed to English.

As schools were few and far from the homes going to school involved traveling through jungles for hours. Hence initially more boys got chance to go to school as parents felt that it would be too tough for the girls. Because of this reason, the school enrolment in the first two-three plan period showed a bias towards the male student.

However, presently the school enrolment ration between male and female has evened out and it will not be surprising if the females lead the enrolment in the near future.

By 2000, Bhutan has one college with 385 educational institutes around the country, which gave the country gross enrolment rate of 89 per cent with the literacy rate of 54 per cent. This shows a great progress over the literacy rate of 23 per cent in 1980.

Food and Nutrition

Nutrition is an integral component of Bhutanese primary health care. The nutritional status of Bhutanese has improved over the years, more significantly for women and children because of an effective network of health care services, increased awareness in health care and growing economic prosperity. However, the overall nutritional status of the population still requires concerted effort from different sectors and agencies to target the probable causes of malnutrition like food shortages, infections, poor dietary habits and child care practices etc.

The Royal Government if paying special attention to problems related to nutrition. Several nutrition and micronutrient deficiency studies has been conducted over past decade. In 1999 the national anthropometric study was conducted. The results of the study indicate marked improvement in the nutritional status of the under five children as compared to the 1989 national nutrition survey (refer table)

Table: Percentage of under five children who are underweight, stunted and wasted.

Micronutrient deficiencies like of iodine deficiency disorder is on the verge of elimination. The 1996 IDD study "tracking progress towards sustainable elimination of IDD" revealed Total Goiter Rate (TGR) of 14%, Median Urinary Iodine level of 298 m /L and iodated salt coverage of 82%.

Following the 1988 survey, the National Assembly adopted a resolution expressing concern for the nutritional well being of all citizens. Special emphasis was given to the importance of nutrition in development.

A more recent survey indicated the continuing problem of food insecurity in Bhutan. This survey, which did not cover the south, much of the east, or remote districts of the north, revealed that 17% of respondents experienced some periods of food shortage. Nearly one-third of these were road workers.

Lifestyle

Basically an agrarian society, people still depend largely on back-breaking agricultural activities in the districts. In the main towns, people work in Government and private offices and there is a general lack of physical exercise in most of them.

Archery is still the most popular sport although the traditional bamboo bow and arrows are getting replaced by expensive modern spring bows and aluminum arrows manufactured abroad. Football is played in schools and towns from time to time in particular seasons.

Rice is the main staple diet followed by maize. Wheat, barley, buckwheat are other food items along with vegetables and meat. Traditionally Bhutanese diet contains more fat from items like pork and butter and most curry items are seasoned with heavy doses of chili. The fat intake is also getting reduced - especially in towns as the people find it difficult to digest fats with the sedentary lifestyle they lead.

Tobacco consumption, both chewing and smoking, once very rampant is now on the decline in the face of the strong advocacy and intervention activities that the health sector is carrying out. Chewing doma, beetle nut with a leaf and some lime, is a habit built into the tradition. Most of the formal get-togethers are punctuated with this item. But today this habit is more common with the elderly people although the younger generation too does resort to this habit.

Another hazardous habit of the Bhutanese is drinking liquor. With strong advocacy from the Government, the situation is much improved