Health Information

Country Health Profiles

Health Programmes

Prevention and Control of Communicable Diseases

Extended Program for Immunization (EPI):

EPI was launched in 1979 with six antigens. In 1988 the National Assembly passed a resolution, which directed the Health Sector to immunize all children. With continued effort Universal Child Immunization was achieved in 1991. Since then the immunization coverage was maintained above 80%.

Multi-antigen National Immunization Days (NIDS) carried out in 1995 (TT, Measles and polio). Since 1996 Sub-national Immunization Days (SNIDS) are carried out . Hepatitis B vaccine was introduced in 1996. Double antigen (Measles & Polio) SNID was carried out in 2000. In the subsequent SNIDS no Measles vaccine was given other than for routine immunization.    

Table: Bhutan National EPI Coverage Evaluation Survey (CES), 2002)

The evaluation survey revealed that 89.7% of the children are fully vaccinated before their first birthday and 64.6% of the fully vaccinated children received valid dose.

As it is becoming too much burden for children and mothers for receiving all these vaccines, Bhutan has been considering the introduction of tetra and penta-valent vaccines and this has been proposed when the country submitted a proposal for GAVI funds.

Both the cold chain system and the human resources are continually developed to support the programme.

Sexually Transmitted Diseases/HIV/AIDS Programme:

The programme on sexually transmitted diseases started in 1988 with the preparation of a short-term plan of action for prevention and control of HIV/AIDS in Bhutan . Bhutan is one of the few countries where the HIV/AIDS control programme started much before the disease entered the country. The programme has well-charted strategies. Clinical screening of blood from sentinel sites and anti-natal clinics helped to screen the problem. A very strong advocacy programme through IEC helped to make the people and the communities aware of the problem and free distribution of condoms from health facilities helped in preventing the infection and controlling birth.

As the disease has shown a rising trend in the recent years, the STD/AIDS programme was reviewed in 2002 to find out the reason and to adjust the control activities for dealing with the problem.

Besides HIV/AIDS, the other sexually transmitted diseases like gonorrhea and syphilis are also under good control right now.

Tuberculosis Control Programme:

Tuberculosis is still a major public health concern despite enormous improvement in its control methods. The TB Control Programme was started in 1976. With technical guidance from WHO, DOTS system has been introduced in the country and medical doctors and nurses are duly trained in this method. Each hospital has a TB in-charge who is responsible for taking care of the reporting new cases and following up on treatment.

Malaria Control Programme: 

Perhaps the Malaria Control Programme is one of the oldest health programmes as it was started in 1964. with the full support of the Government of India. WHO has continued to provide the required technical support and helped the Government to strengthen programme management including training and establishing an entomology unit for the programme. Vector control method has undergone substantial change since 1995. For all practical purposes, comparative analysis of malaria data has been worked out taking 1994 as the base year because the Programme changed its control strategy from Indoor Residual Spraying (IRS) with DDT to Synthetic Pyrethroid which was meant to be a strategy for five years. The IRS was then discontinued in 1997 with the launching of the plan for insecticide treated bed net (ITBN) programme as per the recommendation WHO in the context of the roll-back malaria (RBM) initiative.

Leprosy Control Programme:

The Leprosy Programme was started in 1966 and was consolidated in 1982 and The Leprosy Mission and the Norwegean Santal Mission initially supported it. Though it was implemented as a vertical programme, it is now fully integrated into the general health service. While maintaining the achievements and working towards elimination, the Government is also working to strengthen the programme capacity.

Prevention and control of non-communicable diseases

Community-Based Rehabilitation Programme:

Though the Health Sector took up the community-based disability and rehabilitation programme only in early 1997, some work has been started much earlier by the Education Department. The Education Department started the Zangley Muenselling School for the Visually Impaired in Khaling, Eastern Bhutan decades ago. The Health Sector has identified one hospital as rehabilitation center and presently efforts are put in to develop this center.

Mental Health Programme:

The Community Mental Health Programme was formulated in 1997 coninciding with the beginning of the 8 th Five-Year Plan. WHO and DANIDA played key role in its development by providing both financial and technical assistance. The programme is totally integrated into the general health service. A pilot mental health survey was conducted in 2002. The programme is being strengthened through developing the key staff and health workers.

Primary Eye Care and Oral Health Programmes:

The Department also takes care to prevent blindness with a blindness prevention programme that was initiated in 1987. Eye camps are organized to treat eye problems in the schools and communities. These community level activities are supported by care at the tertiary level. An optical shop supports the programme by providing glasses at a concessional rate.

As oral hygiene is generally poor, an Oral Health Programme was put in place in 1998. The programme conducts regular visits to the schools to examine and medicate the dental problems of school children besides providing normal dental service from the hospitals. Health Sector is experimenting with user-fee charges on cosmetic dental services while the basic oral health and dental services are provided free of charges.

Other Non-Communicable Diseases:

As cases of diabetes, cancer, and rheumatic heart diseases appear to be on the rise, the Health Department is looking into the problem to develop a programme for prevention and control of these problems.

Other Services

Traditional Medicine:

The people of Bhutan depended on this system of healing much before the introduction of western medicines in the country. It is based on the system that is prevalent in Tibet . The traditional medical system was fully integrated into the health service package by 1967. A formal training institute was opened and one hospital was constructed in Thimphu for this purpose. Today all the district hospital have an indigenous service unit within them.

In collaboration with the Agriculture Sector, botanical gardens were established to grow local medicinal herbs. Research and Production Units were started at the National Institute of Traditional Medicine (NITM) using the latest Good Manufacturing Practices. The production of local medicines is still less than the country's requirement. A herbal tea produced by NITM form one of the bi-products of the research in traditional medicine and the tea is gaining popularity.

Essential Drugs Programme:

The Essential Drugs Programme started in 1985 to rationalize the use of drugs and make available an adequate supply of drugs and vaccines to all health facilities at a reasonable cost. The Programme has been evaluated twice, in 1990 and in 1998. The programme supported by the central medical store and the well-established cold chain system has made impressive achievements. A National Drug Committee reviews the essential drugs list annually. Further, the Bhutan Medicines Act is being drafted.

Reproductive Health Programme:

The reproductive health programme, including family planning and mother and child health, constitutes a priority programme of health sector. Given the population growth rate of 3.1% revealed by 1994 National Health Survey, a Royal Decree was issued on population planning in 1995. Since then the population control activities have been intensified which resulted in bringing down the growth rate to 2.5% in 2000.

According to surveys, the percentage of trained birth attendance has increased from 10.9% in 1994 to 23.66% in 2000, which is still low. To reduce the maternal mortality ratio, several comprehensive and basic emergency medical obstetric care (EMOC) centers have been established in the country. The establishments of a wide network of outreach clinics (ORCs) and the development and circulation of a safe motherhood guideline have also contributed to this effort. Further, since 2001, maternal death investigation has been introduced to find out the actual cause of maternal deaths and also to verify them so that effective interventions can be put in place. The country has also instituted the screening of cervical cancers.

Integrated Management of Childhood Illnesses:

Since diarrhoeal diseases and acute respiratory infections top the list of morbidity in health facilities, the programmes on Control of Diarrhoeal Diseases (CDD) and Acute Respiratory Infection (ARI) was started in 1982 and 1987 respectively. Since the initiation of the WHO's Integrated Management of Childhood Illness (IMCI) strategy, these two programmes are combined to form the IMCI Programme

Nutrition Programme:

The Nutrition Programme was established in 1985. As far back as 1970, the National Assembly passed a resolution on universal salt iodization for the country. Periodic cyclic monitoring of the Iodine Deficiency Disorder Control Program (IDDCP) over the last four years also indicates that Bhutan has achieved the WHO goals for IDD elimination. However iron deficiency is still widely prevalent. According to a haemoglobin study conducted for school children in 2001, 58.6% adolescent (school children between the ages 5-15 years) are anaemic. In the 1990s 60% of pregnant women were also anaemic. To address this situation, the Health Sector adopted the policy of universal iron supplements to all pregnant women during pregnancy and lactation.

Nutrition education approaches include the promotion of increased iron intake and improved iron bio-availability through better dietary practices. In addition, vitamin A supplements are given to all children under five along with de-worming tablets and iron and vitamin A to all pregnant and lactating women.

The Public Health Laboratory also provides technical support to this programme in carrying out the cyclic monitoring.

Rural Water Supply and Sanitation (RWSS):

This programme was started under Public Works Department (PWD) in 1974. As this was more relevant to the Health Sector, it was brought under Health in 1998 under the name of Public Health Engineering Section. The programme looks after the supply of clean drinking water and helping the communities in constructing sanitation facilities. A Royal Decree was issued in 1992 requiring every household to have a proper latrine. With all the efforts, the country succeeded in providing access to safe drinking water to 77.8% of the population and covering 88% by sanitation facilities in 2000.

Further, the programme has been able to develop the Rural Water Supply Policy and start drafting the Water Act. The Public Health Laboratory assists this programme in carrying out water quality monitoring.

Information, Education and Communication for Health (IECH) Programme:

The IEC programme supports all other health programmes in advocacy. Although the IEC activities have been carried out much before, the IECH Bureau was formally established 1991. Over the years, this programme, through the use of mass media and its own advocacy systems, has been able to educate the general public about health hazards and motivate the public to change gradually to healthy behaviour. It also helps in developing health education materials for the other programmes and in documenting their progress.

School children are the most receptive of the IECH target groups and their motivation to adopt healthy habits help in motivating other family and community members to change. Thus the Division also runs a comprehensive health programme for school children.

The main concentration of the programme in the recent years has been advocacy against substance abuse and tobacco use and almost all the districts are now declared tobacco free. As the country does not produce any form of tobacco, there is no advertisement of tobacco products.

Village Health Workers (VHW) Programme: 

In keeping with the principles of primary health care, it was seen necessary to extend universal coverage of health services to the rural population and encourage community participation in health activities and awareness. The VHW Programme was thus started in 1978. The VHWs are considered to be the important link between the community and the Government in improving basic hygiene and sanitation, prevention of vaccine preventable diseases, family planning, nutrition, control of diarrhoeal diseases and prevention of sexually transmitted diseases including HIV/AIDS, especially for communities that do not have easy access to health facilities. Presently there are about 1,327 village health workers supporting the normal health programmes.

Training Institutes:

In spite of the acute scarcity of human resource, Health Department manages with adequate workforce of different categories who are well trained in various fields such as clinical, managerial and administrative fields both within and outside the country. The Royal Institute of Health Sciences (RIHS) and the Institute of Traditional Medicine Services (ITMS) are the two main institutes where nurses, paramedical workers, technicians, drungtshos (traditional physicians) and menpas (traditional compounders) are trained. Although only pre-service training is imparted by these two institutes, both in-service and refresher courses including up-gradation courses have been given priority by the Department through the programmes.

The RIHS has been able to conduct BSc. Conversion Course for Nurses in collaboration with the Australian La-Trobe University through affiliation. Established in 1974, RIHS has been the nation's premier institute in the production of various categories of human resource that forms the backbone of the primary health care. In recognition of this fact, the institute received WHO's Primary Health Care Award in 1998. The NITM is also committed to the production of the required human resource for traditional medical services and research in the traditional medicine.

The NITM has produced 36 drungtsos and 34 Menpas and the RIHS has trained 293 health assistants, 189 Auxiliary nurse midewives, 217 general nurse midwives, 263 basic health workers, 173 assistant nurses and 258 technicians of different categories as of 2002.