BHUTAN

Country Profile

Picture source: www.cia.gov                

The Kingdom of Bhutan lies in the Himalayan range of mountains with Tibet, to the north and India to the south.  It has a population of approximately two million inhabitants, at an annual growth rate of 2.2% (2000 estimate).  The official language is Dzongkha, spoken mainly in western Bhutan.  Written Dzongkha is based on the Tibetan script.  The state religion is Mahayana Buddhism, primarily the Drukpa school of the Kagyupa sect, although Nepalese settlers who comprise about a quarter of the country’s total population practice Hinduism.  The Nepali-speaking Hindus dominate southern Bhutan and are referred to as southern Bhutanese. 

Bhutan’s state system is a modified form of constitutional monarchy, thus far without a formal, written constitutional document.  In accordance with a decree law by the King in September 2001, a 39 member special committee convened at the end of the year to draft a constitution.  The system of government is unusual in that power is shared by the monarchy, the Council of Ministers, the National Assembly and the Head of Bhutan’s 3000-4000 Buddhist monks.   

Its gross national product (GNP) in 1998-2000 was US $441 million.  In 1990-2000, GNP per head increased in real terms at an average annual rate of 2.2%.  During the same period, the population increased by an average rate of 3.0% per year.  The gross domestic product (GDP) increased in real terms at 6.3% per year between 1990-2000.  Real GDP growth was estimated at 7.0% in both 1999 and 2000.  Agriculture including livestock and forestry contributed an estimated 38% of GDP in 2000.  About 94% of the economically active population was employed in the sector that year.  Principle sources of agriculture in the sector are apples, oranges, and cardammon.  Timber production is important as about 60% of total land area is covered in forest.

Health care is provided through a four-tiered network of outreach clinics, Bhutan Health Units (BHU), district hospitals and regional hospitals with the national referral hospital at the peak . Through this organized system, access to services with uniform levels of care at the various levels is assured.  At the district level all hospitals are manned by at least one medical doctor. At national and regional levels, where specialized services are available, clinics serve to screen patients needing admission.  The development of doctors who are generalists to serve in district hospitals is encouraged. 

The national policy is one of decentralization to the district level, with the district hospitals and the BHUs under the full control of the Dzongdag or district administrator.  Constraints include lack of eligible candidates to serve as general practitioners, lack of funds, difficult terrain, and inadequate road network and telecommunication facilities. 

Life expectancy during the second evaluation was reported as 45.6 years based on data of 1980-1985.  In 1994, following a national survey using 10% of the population as a sample, the life expectancy at birth was reported to have increased. This increase is attributable to improvement in maternal and child health, immunization, nutrition, water supply and sanitation, control of communicable diseases and higher literacy rates. 

Between 1980 and 1995, the infant mortality rate (IMR) has declined from 102.8 to 70.7 per 1000 live births and the maternal mortality rate (MMR) from 770 to 380 per 100,000 live births. The under five mortality rate reduced from 162.4 to 90.6 per 1,000 live births.  A declining mortality rate and a stationary birth rate of 39.9 per 1000 population has resulted in a high population growth rate of 3%.  Consequently the government has now given high priority to population planning with a target of reducing the growth rate from 3% to 2% by the year 2002.   

The five leading communicable diseases reported for 1995, in rank order, are acute respiratory infections, skin diseases, diarrhoea/dysentery, worms and conjunctivitis.  Acute respiratory infections (ARIs) still tops the morbidity ranking.  It also accounts for 14% of deaths in children under age five.  Acute respiratory infections (ARI) accounted for 14% of infant mortality and diarrhoeal diseases 42% (1994 survey).  With the introduction of ORT, mortality from diarrhoeal diseases has been minimized to some extent.   

Infectious and parasitic diseases are the leading causes of morbidity.  Diseases such as malaria, tuberculosis and leprosy have shown a diminishing trend.  The EPI-target diseases have decreased remarkably.  An increasing trend is seen with ARIs and diarrhoeal diseases.  

Though the quantum drop in infant and maternal mortality is significant, mortality still remains very high.  Indicators of maternal health services need to be improved considerably (e.g. overall only 15.1% of deliveries are attended by trained personnel and in some areas it is as low at 4%) (1994).  Nutritional problems also contribute to maternal and child mortality.  

Although communicable diseases currently continue to hold centre-stage, non-communicable disease concerns such as hypertension, neoplastic diseases and trauma, especially road traffic accidents, are emerging problems.

Protein-energy malnutrition (PEM) and iron deficiency anemia (IDA) remain a public health problem.  The percentage of newborns weighing less than 2500 grams was 16% in 1995.  Approximately 40% of children in 1996 were considered underweight, according to international standards.  Anemia prevalence continues to be remain high among the pregnant women population at 59%.  The prevalence of iodine deficiency disorders (IDD) was 14% (based on urine analysis).  With the introduction of universal iodization of salt and legal control of un-iodized salt, the prevalence of goitre has fallen from 64.5% in 1983 to 14% in 1996 and the cretinism rate from 10% to 0.4% in the same period.  Supplements of vitamin A are given to children at basic health units and iron supplements to anaemic women at maternal and child health (MCH) clinics.  Iodized salt is available throughout the country. 

 Exclusive breast-feeding (up to 4-6 months) and good child feeding practices are promoted. Nutrition information is disseminated through all basic health units.  Seasonal food shortages have been known to compound the nutritional problems.