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Govt. shifts focus from primary to secondary and tertiary health care

The Prime Minister has instructed the health ministry to not construct grade II Basic Health Units (BHU) anymore. All BHUs would provide the services offered by those categorised as level I.

Lyonchhen Dr Lotay Tshering announced this at the Friday meet yesterday where he also said that the government would also switch its focus from primary to secondary and tertiary health care.

Grade I BHU’s are eligible for a doctor, ultrasound, lab and x-ray facilities.

“We don’t have these facilities in grade II so now, we want to raise the bar of BHU II into BHU I level so that Bhutan will only have BHUs,” he said. “Most BHUs are manned by health assistants and assistant clinical officers, and they have done a wonderful job.”

The government would shift its focus to secondary and tertiary health care because the country is graduating and primary health care alone is not enough.

“This is why we wanted to give specialists in districts, ultrasound, lab and radiological services in all the gewogs in the BHUs. This is one of the answers to tackle and identify Non-Communicable Diseases (NCDs).”

The government, he said, has also planned to have a stand-alone multi-dispensary hospital. “So that referrals to India will be history,” he said.

In terms of human resources, Lyonchhen said the government would come up with a policy for BHU’s to be manned by general physicians.  The roles of health assistants (HA) would be between BHUs and homes. “They will visit the houses in the villages, get the list of the people in the cluster, talk to every individual, check their blood pressures, take samples, identify the disease load and bring them to the respective general physicians in that cluster area.”

The general physicians will then identify the needy group and bring them to general hospitals in the districts and regions where there are respective specialists.

That way, he said NCDs would be addressed in a big and professional way. “We are yet to roll that out but we are working on it. If we could do this, I think Bhutan’s health care system would be one of the best.”

Acknowledging the burden of NCDs in the country, Lyonchhen said that a huge chunk of budget was spent on curbing NCDs. However, to relate the burden of NCD with civil servant’s annual health check-up may not be correct. The government was asked on the rejection of the Royal Civil Service Commission’s proposal to conduct an annual health check-up for civil servants due to financial implications.

Lyonchhen said he was unsure about how much of the health check-ups would address the NCD issues and how many Bhutanese people whose lives and quality of life lost to NCDs are in the civil service.

“We have limited resources in terms of manpower, physical infrastructure and equipment and if a big chunk of that equipment at tertiary and secondary levels hospitals are utilised by the annual health checkups, then what would be the implications?” he said.

This was the health ministry’s concern, he said. “The ministry never said NCD was not important or giving annual health checkup to civil servants is not required and not important,” he said. “The ministry’s concern was would our health facilities be able to take up the load. Making it mandatory is good if we can afford but right now we are not able to afford basically in terms of manpower requirement.”

While the country still has a significant burden of infectious communicable diseases, a disease pattern of an underdeveloped country, he said that NCDs like diabetes, hypertension and other lifestyle-related diseases are on the rise.

The country, he said, is at a crossroad. “If we draw a line, NCDs’ uphill line and communicable diseases downhill line are bisecting.”

Dechen Tshomo 

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