Health in Bhutan
Health in Bhutan is one of the
The
The Human Rights Measurement Initiative[6] finds that Bhutan is fulfilling 85.5% of what it should be fulfilling for the right to health based on its level of income.[7] When looking at the right to health with respect to children, Bhutan achieves 91.8% of what is expected based on its current income.[8] In regards to the right to health amongst the adult population, the country achieves only 80.7% of what is expected based on the nation's level of income. [9] Bhutan falls into the "bad" category when evaluating the right to reproductive health because the nation is fulfilling only 84.1% of what the nation is expected to achieve based on the resources (income) it has available.[10]
Health care system
The Ministry of Health has provided universal health care in Bhutan since the 1970s. Health care infrastructure and services are planned and developed through Five Year Plans (FYP) of the Ministry of Health.[11] The third democratically appointed Health Minister, Lyonpo Dechen Wangmo, is the head of the Ministry of Health.[12]
Two major pieces of
Health care facilities
As of 2013, there were 32 hospitals across Bhutan. Most
These hospitals and smaller facilities were supported by 3,756 Ministry of Health employees in thirteen categories: 244 doctors; 957 nurses; 92 nurse's assistants; 505 "health workers;" 35 Dzongkhag Health Officers and Assistants; 41 drungtshos (traditional physicians); 52 smenpas (traditional physicians); 12 pharmacists; 79 pharmacy assistants and technicians; 13 lab technologists; 549 other technicians and assistants; and 1,601 administrative and support staff.[1]: iii
Emergency and health hotline
On May 2, 2011, Bhutan launched its telephonic Health Help Centre (HHC), which had proved successful over the prior two months. The HHC number is 112. The HHC provides two services: Emergency Response and the Healthcare Helpline, both accessible through landed and mobile phones. Emergency responses are served by 61 ambulances in 37 locations with 59 emergency medical technicians around the kingdom, equipped with
Funding
The cost and availability of health care facilities – some of which operate on a 24-hour basis – is a subject of discussion in Bhutan. Issues of affordability and sustainability have called into question Bhutan's proposed funding schemes.[16]
Health issues
As of 2009, most Bhutanese had access to potable drinking water (83%) and basic sanitation (91%). Widespread health concerns included diarrhea (2,892 per 10,000 people) and pneumonia (1,031) among children under age 5; skin infections (1,322); conjunctivitis (542); hypertension (310); and intestinal worms (170). Less widespread were diabetes (38 per 10,000 people); alcohol-related liver disease (23); and cancer (17). Incidence of malaria and tuberculosis was generally low, at 10 and 15 cases per 10,000 people, respectively.[1]: iii, 4–5
HIV/AIDS
In 2011, there were 246 reported cases of HIV, representing just over 0.3% of the population.[17] Through 2010, infection rates remained modest though increasing, totaling 185 reported cases, or 0.1% of the population. The Ministry of Health attributed climbing numbers to promiscuity, drug use, and the prevalence of HIV/AIDS in neighboring countries.[1]: 4
Maternal and child healthcare
As of 2008, 90% of the population were covered by the government's immunization regimen.[1]: iii In 2010, the Ministry of Health noted a growing trend of unsafe abortions among Bhutanese women (466 in 2003; 1,057 in 2009), apparently performed in neighboring India, contributing to Bhutan's high maternal mortality rate.[1]: 3
In 2011, Bhutan had a maternal mortality rate of 200 per 100,000. This is compared with 254.9 in 2008 and 1145.4 in 1990. The under 5 mortality rate, per 1,000 births was 81 and the neonatal mortality as a percentage of mortality under 5 years was 43. In Bhutan the number of midwives per 1,000 live births was 15 and the lifetime risk of death for pregnant women was 1 in 170.[18]
Food safety
Bhutan regulates public health and safety in regards to food under the Food Act of 2005.[19] The Food Act establishes the National Food Quality and Safety Commission and the Bhutan Agriculture and Food Regulatory Authority ("BAFRA"), both of which are overseen by the Ministry of Agriculture. While the Ministry of Agriculture is singularly authorized to author regulations under the Food Act, the Minister of Agriculture may delegate authority to ministries responsible for health, trade, and customs.[19]: §§ 3–9, 88
The National Food Quality and Safety Commission is chaired by the Minister of Agriculture and comprises ten additional members from various relevant government ministries and agencies regulating agriculture, health, commerce, home affairs, legal affairs, and the environment.[19]: § 10 The Commission formulates the government's food policy, while the BAFRA is responsible for advising and implementing the Commission's policies, including health and safety inspections.[19]: §§ 15–21, 33–52
BAFRA inspectors have broad authority to search, document, test, and seize food wherever it is transported, stored, prepared, or served; inspectors may also destroy unsafe food when it poses a "clear and present danger for human health or the environment".[19]: §§ 39–49 The Act further establishes health guidelines for businesses that serve or trade in food, including provisions allowing for food testing,[19]: §§ 53–58 and defines government authority in regulating food imports and exports.[19]: §§ 61–67 The Food Act, like other Bhutanese legislation, defines relevant offenses and penalties for failing to conform to proscribed laws and regulations.[19]: §§ 58–87
Tobacco
The Tobacco Control Office is occupied by the Bhutan Narcotic Control Agency and headed by its executive director. The Office acts as the
Alcohol
In 2011, the government passed its Alcohol Control Regulation, which imposed up to three times the previous taxes on alcohol. As a result, alcohol sales have dropped and prices have risen.[20] Alcohol consumption among students has risen in the recent past, resulting in several expulsions from Bhutan's elite Sherubtse College.[21]
Through government efforts to reduce ara production and consumption in Lhuntse District, eastern Bhutan, locals conceded something should be done to curb the distinctly eastern Bhutanese tradition of heavy drinking. The government's strategy is to reduce ara production and consumption gradually until it is eliminated. Alcoholism and ara production have been notable topics of political discussion Bhutan, especially at the local level.[26] Ara, however, is also culturally relevant for its religious and medicinal uses.[27][28]
Narcotics and treatment
Bhutan regulates drugs – from pharmaceuticals to narcotics – through the Narcotic Drugs and Psychotropic Substances and Substance Abuse Act 2005 ("Narcotics Act").[4] Its stated legislative purpose is "to ensure that drugs are available exclusively for medical, veterinary and scientific purposes." To this end, the Narcotics Act emphasizes education and treatment as means of combatting illegal drug use.[4]: §§ 35–42 The Act sets forth a fivefold schedule for substances under which Schedule I includes the most restricted substances and Schedule V includes substances "liable for abuse but [not falling] under International control."[4]: §§ 3–6, i–v
To address drug-related issues, the Narcotics Act creates the Narcotics Control Board and the Narcotics Control Agency. The Narcotics Control Board, made up entirely of government appointees and chaired by "a relevant Cabinet Minister," is responsible for formulating drug policy,[4]: §§ 59–63 while its ancillary Narcotics Control Agency is chiefly responsible for implementing the Board's policy and advising the Board.[4]: §§ 64–79 The Narcotics Act provides enforcement and investigation powers to drug enforcement agencies, including the Royal Bhutan Police and Narcotics Control Agency.[4]: §§ 70–86 Under the Narcotics Act, every person and entity is subject to inspection by competent authorities.[4]: §§ 26–30, 70–71
The Narcotics Act mandates drug treatment under the auspices of the Narcotics Control Board and punishes repeat offenders and those who otherwise fail to abide by the terms of treatment.[4]: §§ 50–53 The Board is bound to ensure treatment, rehabilitation, and social reintegration of drug-dependent persons, through interventions, counseling, and detoxification; it is thus required by law to maintain adequate personnel and institutions to provide such services.[4]: §§ 38–39 Records of treatment must be kept confidential.[4]: § 56 Persons dependent on drugs are subject to compulsory treatment and rehabilitation; those who refuse to submit voluntarily must be confined in criminal custody.[4]: §§ 36–55
The Act authorizes courts to impose treatment as part of sentencing in cases related to drugs, and provides for probation-like "periodic attendance before a panel for review and evaluation of treatment and progress." Successful compliance with such a regimen allows courts to discharge other penalties related to narcotics, such as prison terms and fines.[4]: §§ 44–47, 57 [29] The Narcotics Act further sets forth about a dozen offenses and penalties regarding compliance with the Act, further supplementing the Penal Code.[4]: §§ 90–103
The Bhutanese media, for its part, have recognized dire societal problems resulting from and associated with substance and alcohol abuse. In response, the Bhutan Observer has encouraged religious and community support for those seeking recovery.[30]
Suicide
Bhutan's suicide rate was 16.2 per 100,000 people in 2011. This figure ranks the kingdom as the 20th-highest suicide rate in the world, and the 6th highest in the
Since 2011, the number of recorded deaths has increased by around 50% for the years 2012 and 2013,[32] which clearly places the Himalayan Kingdom among the countries with the highest suicide rates in the world. Bhutan is currently rated at number five in the Asia Region.[33] While no clear indications are given for Bhutan's high rate of suicide, lack of job opportunities, an extremely high percentage of broken families and a high rate of domestic violence are considered to be major contributing factors.
History
Training for health care assistants, nurses' aides, midwives, and primary health care workers was provided at the Royal Institute of Health Sciences associated with the Jigme Dorji Wangchuck National Referral Hospital, which was established in 1974. Graduates of the school were the core of the national public health system and helped staff the primary care basic health units throughout the country. Additional health care workers were recruited from among volunteers in villages to supplement primary health care.[34]
The government has maintained a system of universal health care for its citizens. However, the number of Hospitals in Bhutan has been limited, and some diseases, such as cancer cannot be treated in Bhutan. Patients that cannot be treated in Bhutan are taken to hospitals in India, and their treatment is paid for by the government of Bhutan.[34]
The most common diseases in the 1980s were gastrointestinal infections caused by waterborne parasites, mostly attributable to the lack of
It was estimated in 1988 that only 8 persons per 1,000 had access to potable water. Despite improved amenities provided to the people through government economic development programs, Bhutan still faced basic health problems. Factors in the country's high morbidity and death rates included the severe climate, less than hygienic living conditions, for example long-closed-up living quarters during the winter, a situation that contributes to the high incidence of leprosy, and smoke inhalation from inadequately ventilated cooking equipment. Nevertheless, in 1980 it was estimated that 90 percent of Bhutanese received an adequate daily caloric intake.[34]
Although there were no reported cases of
See also
- Jigme Dorji Wangchuck National Referral Hospital (Thimphu), Bhutan's main hospital
- Abortion in Bhutan
- Tobacco Control Act of Bhutan 2010
- Traditional Tibetan medicine
- Pema Dorji, a doctor of traditional Bhutanese and Tibetan medicine, the first person to institutionalize traditional medicine in Bhutan
Further reading
- Dorji, Tandi; Melgaard, Bjorn (2012). Medical History of Bhutan:chronicle of health and disease from Bon times to today. Thimphu: Centre for Research Initiatives.
- Taee, Jonathan (2017). The Patient Multiple: An Ethnography of Healthcare and Decision-Making in Bhutan. Berghahn Books.
References
- ^ ISBN 978-99936-767-2-0. Archived from the original(PDF) on 2011-07-06. Retrieved 2011-03-10.
- ^ Government of Bhutan. 2010-06-16. Archived from the original(PDF) on 2012-03-16. Retrieved 2011-01-20.
- Government of Bhutan. 2009. Archived from the original(PDF) on 2011-07-06. Retrieved 2011-03-10.
- ^ Government of Bhutan. 2005-11-30. Archived from the original(PDF) on 2012-03-21. Retrieved 2011-03-25.
- Government of Bhutan. 2008-07-18. Archived from the original(PDF) on 2012-09-04. Retrieved 2011-03-02.
- ^ "Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries". humanrightsmeasurement.org. Retrieved 2022-03-13.
- ^ "Bhutan - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-13.
- ^ "Bhutan - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-13.
- ^ "Bhutan - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-13.
- ^ "Bhutan - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-13.
- Government of Bhutan. Archived from the originalon 2011-03-08. Retrieved 2011-03-10.
- Government of Bhutan. Archived from the originalon 2011-01-04. Retrieved 2011-03-10.
- ^ Government of Bhutan. 2002-07-24. Archived from the original(PDF) on 2011-07-06. Retrieved 2011-03-02.
- ^ Government of Bhutan. 2003-08-05. Archived from the original(PDF) on 2011-07-06. Retrieved 2011-03-02.
- ^ Meena; Yasuda (2011-05-10). "Medical Advice a Dial Away". Bhutan Observer online. Archived from the original on 2011-07-13. Retrieved 2011-07-14.
- ^ Wangchuck, Kinley (2010-06-26). "Off-Hour Clinic: A Blow to GNH". Bhutan Observer online. Archived from the original on 2011-01-19. Retrieved 2011-07-14.
- ^ "The Ministry of Health has Detected…". Bhutan Observer online. 2011-08-01. Retrieved 2011-11-21.
- ISBN 978-0-89714-995-2. Retrieved 2011-07-14.
- ^ Government of Bhutan. 2005-11-30. Retrieved 2011-03-25.
- ^ Wangchuck, Jigme (2011-05-10). "Regulation and Duty Hit Bars". Bhutan Observer online. Archived from the original on 2012-08-15. Retrieved 2011-07-14.
- ^ Lhadon, Pema (2011-07-13). "Drinking Habit Peaks at the Peak of Learning?". Bhutan Observer online. Archived from the original on 2012-08-15. Retrieved 2011-07-14.
- ^ Mowe, Sam (2011-06-02). "Making Moonshine: How to Make Bhutanese Rice Wine". Tricycle online. Retrieved 2011-07-27.
- ^ Wangdi, Tempa (2011-01-27). "Ara Production and Sale Should Be Legalized, Farmers Say". Bhutan Observer online. Archived from the original on 2011-02-07. Retrieved 2011-07-27.
- ^ Namgyal, Gyembo (2011-03-15). "Reduce Alcohol Abuse, Lyonchhen Urges Local Leaders". Bhutan Observer online. Archived from the original on 2012-04-03. Retrieved 2011-07-27.
- ^ Namgyal, Gyembo (2011-07-18). "Alcohol Price Hike Doesn't Quite Discourage Drinking". Bhutan Observer online. Archived from the original on 2011-07-26. Retrieved 2011-07-27.
- ^ Wangchuck, Jigme (2011-09-05). "Ara Faces Banishment in Lhuentse". Bhutan Observer online. Archived from the original on 2011-09-07. Retrieved 2011-09-08.
- ^ Namgyal, Gyembo (2010-01-19). "It is Lhasoel Time in the East". Bhutan Observer online. Archived from the original on 2011-01-20. Retrieved 2011-07-27.
- ^ Dema, Tashi (2007-06-04). "Trongsa: Slithering with Snakes". Kuensel online. Archived from the original on 2012-04-02. Retrieved 2011-07-27.
- Government of Bhutan. 2004-08-11. Retrieved 2011-01-21.
- ^ Palden, Sonam (2011-07-08). "Finding a Shared Ground". Bhutan Observer online. Archived from the original on 2011-07-13. Retrieved 2011-07-14.
- ^ Suicide in Bhutan
- ^ "Second Biggest Killer in Bhutan". Archived from the original on 2013-11-03. Retrieved 2015-10-17.
- ^ Ranked Number Five in Asia
- ^ a b c d e This article incorporates text from this source, which is in the public domain. Robert L. Worden (September 1991). Andrea Matles Savada (ed.). Bhutan: A Country Study. Federal Research Division. Health.
External links
- "Ministry of Health - Royal Government of Bhutan". Government of Bhutan. Retrieved 2011-03-10.