Health Information

Country Health Profiles

Health Resources

Physical infrastructure

Health service is provided through a four-tiered network consisting of a National Referral Hospital, Regional Referral Hospitals, District Hospitals and Basic Health Units. There are 30 hospitals including one hospital for traditional medicine and 160 basic health units. These facilities are supported by 447 out-reach clinics at the community level. Traditional medicines services are available in all the districts.

Table: Health Infrastructure

Health infrastructure expansion took place in the 1970s reaching the peak of expansion activities in the 1980s. In line with the Alma Ata Declaration, the country committed itself to establishing a relevant and cost-effective health care delivery system based on the primary health care approach. Despite the high cost of health care service delivery in a country with a population scattered thinly over the mountainous terrain, Bhutan has managed to establish a fairly uniform spread of Basic Health Units, District Hospitals, and Regional Referral Hospitals.

Financial resources for Health

Although only 2.9% of total outlay for the First Plan (1962-1967) was given for health, the Government recognized the importance of the social sectors. The current Government allocation for Health is around 10% of the total outlay, which comes to 4% of the GDP. This is perhaps the highest allocation for health in the Region.

Figure: Plan Outlay in Million Ngultrums.

In the past Plans, donors played a significant role in supporting the health sector. However, to reduce the over dependence on donors the Government is now taking steps to bear the major portion of the cost. On an average the Government now bears about 49% of the total outlay.

The main development partners in the health sector are Governments of India, DANIDA, UNICEF, UNFPA, WHO.

Human resources for Health

Table: HRD indicators

Along with the expansion of health infrastructure, human resources for the Health Sector have also been built steadily over the years. The country still faces shortage of medical personnel with only 109 doctors. Developing medical doctors is still very difficult as Bhutan has to depend on the neighboring countries as Bhutan does not have any institute. Candidates are sent to Bangladesh, India, Myanmar, and Sri Lanka for their MBBS course.

Other categories of middle and lower level human resource is developed by the country itself at the Royal Institute of Health Sciences. This institute that got the WHO's 50th Anniversary Award for Primary Health Care, is the main contributor to the primary health care development in Bhutan in terms of human resource. The institute trains health assistants (HA), basic health workers (BHW), auxiliary nurse-midwife (ANM), general nurse midwife (GNM), assistant nurse (AN), and technicians of various disciplines (laboratory, pharmacy, dental, x-ray, ophthalmology, physiotherapy, operation theatre). With the support of WHO, this institute is now affiliated to La Trobe University in Australia to train nurses at post-basic level.

On the other side, the National Institute of Traditional Medicines trains both full-fledged traditional physicians, Drungtshos and the Menpas to support them.

Essential Drugs and other supplies

Bhutan has no pharmaceutical industries and relies on imports for its entire requirement. Traditional medicine is manufactured at the National Institute of Traditional Medicine Services (NIMS) in Thimphu. Although the country succeeds in making the programme self-sufficient in terms of budget after the operationalization of the Health Trust Fund, the country will still be dependent on the outside world for the actual drugs, vaccines and other supplies like laboratory reagents and medical equipment.

Presently the country has one of the best programmes in the South-East Asia Region. With an effective medical supplies management and the systematic drug indentation system, an average of 80% of all essential drugs allocated to hospital and Basic Health Units were found to be available on one particular day in 1998.

As Bhutan is dependent on the outside world for the medicines, vaccines and reagents, quality control in a way is out of hands of the Bhutanese. In this regard, Bhutan relies on WHO collaborating laboratories in the Region for testing the quality of imported drugs and vaccines.