Health in Bhutan

, Wangdue Phodrang District. 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. The third democratically appointed Health Minister, Lyonpo Dechen Wangmo, is the head of the Ministry of Health. Two major pieces of Bhutanese legislation establish a framework for personnel and medicines. The Medical and Health Council Act of 2002 incorporates the Medical and Health Council as a legal entity to regulate medical schools, courses, and professional credentials. The Medicines Act of 2003 establishes the Bhutan Medicines Board and Drugs Technical Advisory Committee. The Act authorizes several subsidiary organizations, including the Bhutanese Drug Regulatory Authority, Drug Testing Laboratory, and teams of Drug Inspectors. These agencies have rulemaking and law enforcement authority on drugs, medicines, and even price controls, but must operate within the laws of Bhutan. Both pieces of legislation contain offenses germane to their subject matter, supplementing the Penal Code. 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. 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. ==Health issues==

in Bhutan. Over 90% of Bhutanese have access to basic sanitation. 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. 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. Food safety Bhutan regulates public health and safety in regards to food under the Food Act of 2005. 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. The Act also authorizes the Tobacco Control Board, through the Tobacco Control Office, to provide cessation programs in health facilities and to work with rehabilitation centers in diagnosing and counseling tobacco dependence. Alcohol consumption among students has risen in the recent past, resulting in several expulsions from Bhutan's elite Sherubtse College. Ara, the traditional alcohol of Bhutan, is most often home made from rice or maize, either fermented or distilled, and may only be legally produced and consumed privately. Ara production is unregulated in both method and quality, and its sale has been prohibited in Bhutan since a severe crackdown. However, because Ara returns far more profit than other forms of maize, many Bhutanese farmers have pressed for legal reform. The Bhutanese government, meanwhile, is intent on discouraging excessive alcohol consumption, abuse, and associated diseases through taxation and regulation. 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. Ara, however, is also culturally relevant for its religious and medicinal uses. Narcotics and treatment Bhutan regulates drugs – from pharmaceuticals to narcotics – through the Narcotic Drugs and Psychotropic Substances and Substance Abuse Act 2005 ("Narcotics Act"). The Narcotics Act further sets forth about a dozen offenses and penalties regarding compliance with the Act, further supplementing the Penal Code. 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 Asia-Pacific region. Since 2011, the number of recorded deaths has increased by around 50% for the years 2012 and 2013, 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. 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==

in Bhutan Bhutanese health care development accelerated in the early 1960s with the establishment of the Department of Public Health and the opening of new hospitals and dispensaries throughout the country. By the early 1990s, health care was provided through twenty-nine general hospitals (including five leprosy hospitals, three army hospitals, and one mobile hospital), forty-six dispensaries, sixty-seven basic health units, four indigenous-medicine dispensaries, and fifteen malaria eradication centers. The major hospitals were in Thimphu, Geylegphug, and Trashigang. Hospital beds in 1988 totaled 932. There was a severe shortage of health care personnel with official statistics reporting only 142 physicians and 678 paramedics, about one health care professional for every 2,000 people, or only one physician for almost 10,000 people. 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. 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. 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) through the early 1990s, 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. ==See also==