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Health policies and strategies
The
Royal Government gives great importance to the social sectors- especially
education and health. The Government pursues a policy of providing essential
health care services free of charge.
In
order to sustain achievements in Primary Health Care and reduce the
dependency on donors, the Royal Government has initiated the creation of a
Health Trust Fund. The total capital for the Health Trust Fund has been
initially set at US $ 24 million. As per the Royal Charter of the Health
Trust Fund, the Royal Government will match, on a one-to-one basis, any donor
contribution to the Fund. The fund will be maintained in US dollars and
invested in reliable financial institutions abroad. It will be governed by
the Management Board consisting of high-level members
representatives from the relevant Ministries and organizations.
This
initiative is expected to support the Royal Government's policy of providing
free essential health care.
For
the purpose of maintaining quality of health care service and protecting the
qualified human resource for health, private practice has never been
introduced.
As
the traditional medicine practiced in Bhutan, Sowa Rigpa,
is a systematic field of knowledge, traditional medical care is provided side
by side with modern allopathic health care. These two systems are now more or
less integrated.
Within
the overall long-term objective of the Health Ministry, "attaining a
healthy living standard by the people living within the broader framework of
the overall development of the country", there has been a shift from
expansion of services which was emphasized in the earlier plans to the
quality of services which entails setting up of standards at various levels
of health care delivery system. Strategies have been developed to reach the
un-reached through decentralization of planning and management systems; to
strengthen management information system, to develop research and their use
which leads logically to one of the Ministry's most important objectives:
intensifying human resource development for health and establishing a system
of continuing education. To this end, the Ministry has developed the Master
Plan for Human Resource as a guide for developing human resource for health.
Intensification
of prevention and control of prevailing health problems and dealing with the
emerging and re-emerging ones require extra resources and effort and the
Ministry has prepared itself in dealing with this problem. Other objectives
that have flowed from the past plans are intensification of reproductive
health services and sustaining population planning activities; promoting
community-based rehabilitation, mental health, and finding innovative means
to enhance the mental well-being of the people; and maintaining balance
between primary, secondary, and tertiary health care so that the higher
levels of service can back up the needs created or problems identified by the
lower ones.
With
the intentions on health coverage, the Royal Government has not been able to
give a legal framework for medical services both to protect the medical
practitioners and the patients. Now the Bhutan Medical and Health Council Act
has been passed by the National Assembly in 2002.
Further, the Medicines Act is being drawn up to regulate the sell of the
medicines, drugs and other substances in the country.
Managerial process
The
Ministry of Health and Education is headed by a Minister. A Secretary looks
after both the Health and Education affairs at policy level. The Health
Department is headed by a Director. Please see the organogram
in Annexure.
The
health services in the districts are directly under the administration of the
Dzongdag, district magistrate. The Health
Department provides technical support to the districts. District Medical
Officers look after the hospitals and District Supervisory Officers look
after the primary health care concerns in the districts. The Basic Health
Units at the community level are directly under the administration of the
District Health Supervisory Officers.
However,
in line with good governance policy, the Royal Government has now decided to
restructure the Ministry of Health and Education into two separate
Ministries.
Organization of the health system
The
basis for Bhutan's
health care delivery system is the primary health care system starting with
the 445 outreach clinics and 163 basic health units at the community levels.
The districts have the district hospitals organized under the three Regional Referral
Hospitals and one of these Regional
Referral Hospitals also serve as the National Referral
Hospital.
Patients
at the basic health unit level are referred to their respective district
hospitals for secondary or tertiary health care. The district hospitals
likewise refer to their respective Regional Referral Hospitals and that in
turn rely on the National
Referral Hospital.
As it is not yet possible to have very specialized health care in the
country, a good number of cases requiring such health care are referred
outside the country.
The
health service system at the district and lower levels depend on the district
authorities for their administrative support and on the Health Department at
the centre for technical support. The basic health units submit their case
reports directly to the District Supervisory Officers who compiles them and
submit to the Health Department at the national level. However, the diseases
under strict surveillance like HIV, Poliomyelitis, etc. that come under the notifiable category are reported directly to the national
level immediately.
Community participation
In
order to bridge the gap between the organized health service and the
community, the Government trains village health workers who are chosen by the
communities themselves. As of 2000, there are 1,327 village health workers
who advocate health to the people and who help in bringing the health problem
of the people in the communities to the health workers. They are also taught
and allowed to dispense a few basic allopathic medicines.
The
communities also look after the development schemes like those for drinking
water supplies in their own areas. The programme
assists the communities by providing them the required training.
Then
there are the traditional faith healers, astrologers and religious leaders in
the communities. The Ministry also takes the support of these respected
people in imparting specific health messages -ranging from the need to take
iodized salt to family planning - to the people in the communities along with
their routine work.
Health information system
Realizing
the importance of information in management, Health Information Unit was
established in 1983. Since then the Annual Health Bulletin was compiled on a
yearly basis and published. WHO has put in substantial support to develop the
Health Information System in the 1990s. During
1999-2000, the information system was reviewed and the Health Information
Management System was instituted with support from DANIDA. Presently HMIS is
being computerized and experimented.
The
basic health facilities have been given standardized reporting forms to
report the morbidity, mortality and other health data collected at that
level. This is compiled and consolidated every month and submitted to the
District Health Supervisory Officers who, in turn, compiles and submits to
the national level every quarter. At the national level the Health
Information Unit compiles and makes it available to all concerned.
However,
the human resource for the Health Information Unit has to be further improved
both in terms of expertise and number to make the Health Information System
dynamic and helpful for evidence-based planning for the future.
Inter-sectoral
coordination
Intersectoral coordination at different levels of the
Government is achieved through different ways. At the national level, the
Planning Commission coordinates the plans of various development sectors and
the Department of Aid and Debt Management of the Ministry of Finance
coordinates resource allocation. At the district level, when the plans are
implemented, the Dzongdag is the overall head. All
the sector representatives at the district level function under the Dzongdag. Thus duplication of efforts is avoided and the
actions are coordinated.
Even
at the Department and programme level, there are a
lot of coordination mechanisms through Policy and Planning Division of the
Ministries. Additionally, individual programmes
have their own coordination mechanism with other concerned sectors. Malaria programme, for instance, has direct coordination
mechanism with the agriculture and municipal departments. Similarly
environmental health programme liaises with the
National Environment Commission, Municipal Corporations of each district and
even the police force. The nutrition coordinates its efforts with the
Agriculture, Trade, and other relevant sectors. Further, there are the multi-sectoral task forces that also address the issues that
cut across many sectors.
Emergency preparedness
Of
the numerous emergency situations, the one that concerns the country most is
the traffic accidents. Flash floods and landslides also contribute to the
problem. The country being in an earthquake zone, severe earthquake is also
read about in its history but it is less frequent. Glacial flood also cause
damage to the life and property. A rough study in the recent years revealed
numerous glacial lakes that are potentially dangerous to the country.
Further, of late the presence of the militants from across the southern
border poses an enormous threat to the national peace and security.
In
order to deal with all these eventualities, the Ministry of Health and
Education has established a rapid response team consisting of several
relevant sectors. An emergency medical team further backs this establishment.
Health research
Health
research is comparatively new for Bhutan
although Bhutan
has been a participant to WHO's research
consultations in Region. To be able to carry out research for the health sector
so that there will be evidence-based health interventions; the country has
been building its research unit. The Research Unit was formally established
in 1995. The key staffs are still being trained abroad. The unit has played
crucial roles in conducting vital studies for health in the recent years. It
has contributed in the conducting of the National Health Survey in 2000 and
in carrying out the survey on mental health in 2002.
Coming
to the area of other kinds of research, the Pharmaceutical and Research Unit
at the National Institute of Traditional Medicines conduct research related
to indigenous medicines. Further it is also documenting the medicinal plants
and herbs that are found in Bhutan.
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