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Country Health Profiles

Trends in Health Status

Reviews conducted in 1984, 1994 and 2000 revealed good progress in the health sector since the start of the planned development four decades ago. Maternal mortality ratio has decreased from 7.7 per 100,000 live births in 1984 to 2.55 in 2000. Infant mortality rate has also dropped from 102.9 per 1,000 live births to 60.5 during the same period. Bhutanese life expectancy has increased from years in 48 years in 1984 to 66 year in 1994. Even the population growth rate of 3.1%, which was a concern for the government, has also dropped to 2.5% by 2000 through intensified health education and increased access to contraceptives. In a rugged country like Bhutan, access to trained birth attendant was as low as 10.9 % in 1994. This has increased to 23.6% in 2000.

Table 1: health indicators

Source: National Health Survey 2000

The cure rate for tuberculosis is 90 per cent and the case fatality rate show steady decline from 48.8 per 1000 cases in 1995 to 45.6 in 2001. DOTS strategy has been used since 1997 and standard reporting and recording system for patients are in place although there are still cases of double recording or patients lost to follow up. However, the increasing number of HIV cases is now challenging this progress.

Bhutan has been smart enough for being able to put a programme on STD/AIDS in place long before the entry of HIV/AIDS into the country. This preparedness has been put into test when the HIV problem entered the country in 1993. As the country shares a porous border with some of the highly infected areas of India in the south and is connected with Myanmar, Thailand and Nepal by air, it was not going to be spared from this problem. Although the knowledge about the dangers of HIV/AIDS has been instilled to more than 80% of the population, the toleration of promiscuity and re-marriages in the society makes the problem of STDs, especially HIV/AIDS very grave. By the year 2002, there were 38 HIV positive cases detected in the country of which 22 were males and 16 were females. Out of this 7 have died and 31 are still living. Taking into account only detected cases, there has been almost 100 per cent increase in the cases between 2001 and 2002 as can be seen in the following graph.

For malaria, capacity for control has certainly been increased with the strengthening of the programme and establishment of an entomological unit. Efforts are bearing fruit as indicated by the Plasmodium falciparum and Plasmodium vivax cases as these are two prevalent types of malaria in the country. Plasmodium vivax was seen as the most predominant infection all through the decade from 1990. However Plasmodium falciparum cases exhibited a sudden increase to 12,966 in 1991 as compared to Plamodium vivax cases of 9,160 during the same year.

On the whole the malaria situation started to get worse from 1990 onwards with Annual Parasite Infection increasing from 53.6 reaching a peak of 111.1 in 1994. After that the annual infection showed marked improvement between 1995 and 2000 with a declining trend from 66.2 to 16.9 with a some increase 1999.

Despite the progress made so far, as most of the malarious districts share common border with malarious districts in India, more work needs to be done to coordinate control activities.

Leprosy is currently under control with a prevalence rate of 0.61 per 10,000 population with a case detection rate was found to be 0.29/10,000. As in the past, no reconstructive surgery was offered due to negligible number of cases.

Effort continues to maintain immunization coverage above 80% for vaccine preventable diseases. The sub-National Immunization Days continue twice a year to reach the un-reach so that Bhutan may achieve eradication of poliomyelitis by 2005. Though there has not been a case of poliomyelitis reported since 1986, focused surveillance continues for acute flaccid paralysis (AFP).

While some progress has been made in controlling communicable diseases, there is an ever-growing problem of non-communicable diseases. With the changing of life-style from the agrarian society to more complex modern competitive world, rheumatic heart diseases, diabetes, cancer, especially cervical cancer are on the increase. Even within a peaceful country like Bhutan, preliminary assessments reveal that the situation of mental health is not much different from any other country. Presently most of cancer cases are referred outside the country that drains a large portion of the hospital outlay. The Government is now initiating actions to have programmes in place to deal with this aspect of health problem.

Acute respiratory infections in winter and diarrhoeal diseases in summer still top the list of infant morbidity in the basic health units. This is usually attributed to poor nutrition and living environment of the children in the rural communities, dry atmosphere in the winter, poor quality of drinking water and sanitation in summer. The programmes on Integrated Management of Childhood Illnesses, Water Supply and Sanitation, Nutrition have been working to improve the situation but more work is required to coordinate their efforts to impact positively on child health.