Bhutan’s modern health care development accelerated with the establishment of the Department of Public Health in the 1960’s and the opening of new hospitals and dispensaries throughout the country. However careful attention had always been given to traditional practice and the people’s perception of illness. This has ensured that modern healthcare services and indigenous medical services develop simultaneously.
Herbal-based, traditional medicine is well established and integrated into the general health services and remains a popular form of healthcare.
Access to traditional medicine in the country has been greatly increased with 31 traditional Drungtshos (Doctors) providing indigenous medical services in all Dzongkhags (Districts). Traditional medicine continues to hold an important place in the formal healthcare system as it not only adds an important dimension to the country’s system of healthcare, but also provides an alternative form of healthcare.
An integrated healthcare delivery system was foreseen as an effective strategy to reach the scattered population in Bhutan’s rugged terrain. The declaration of Alma Ata in 1978 adopting a primary healthcare approach to achieve ‘Health for All’ has also served accelerate health service development in this direction.
The government has maintained a system of complete free healthcare for not only the Bhutanese citizens but also all those who reside in the country. In 1961 there was hardly any modern facility in Bhutan. Today, the country has more than 29 hospitals, 160 Basic Health Units and 90 percent health coverage with basic services. The health status of the population has improved markedly, especially during the last 10 years. National surveys conducted in 1984, 1994, and 2000 showed a tremendous increase in the access to safe drinking water and dramatic decrease in mortality and morbidity. The population growth rate has been brought down from 3.1 percent in 1994 to 2.5 percent in 2000.
Training for health-care assistants, nurses’ aides, midwives, and primary health-care workers is provided at the Royal Institute of Health Sciences associated with the Jigme Dorji Wangchuck National Referral Hospital, Thimphu, which was established in 1974. Graduates of the school are the core of the national public health system and helped staff the primary care basic health units throughout the country. Additional health-care workers are recruited from among volunteers to supplement primary health care.
The most common diseases in the 1980s were gastrointestinal infections caused by waterborne parasites, mostly attributable to the lack of clean drinking water. The most frequently treated diseases were respiratory tract infections, diarrhea and dysentery, worms, skin infections, malaria, nutritional deficiencies, and conjunctivitis. In 1977 the World Health Organization (WHO) declared Bhutan a smallpox-free zone. In 1979 a nationwide immunization program was established. In 1987, with WHO support, the government envisioned plans to immunize all children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by 1990. The government’s major medical objective by 2000 was to eliminate waterborne parasites, diarrhea and dysentery, malaria, tuberculosis, pneumonia, and goiter. Progress in leprosy eradication was made in the 1970s and 1980s, during which time the number of patients had decreased by more than half, and by 1988 the government was optimistic that the disease could be eliminated by 2000.
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.
Although there were no reported cases of acquired immune deficiency syndrome (AIDS), the Department of Public Health set up a public awareness program in 1987. With the encouragement of the WHO, a “reference laboratory” was established at the Thimphu General Hospital to test for AIDS and human immunodeficiency virus (HIV) as a precautionary measure. To further enhance awareness, representatives of the National Institute of Family Health were sent to Bangladesh in 1990 for training in AIDS awareness and treatment measures.
The Government maintains a system of universal health care for all of its citizens. However, the number of Hospitals in Bhutan is 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.