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Health and politics

To protect the lives of children and the elderly, the health ministry announced the introduction of three new vaccines this week.

Starting next January, the pneumococcal, rotavirus and flu vaccine will be administered to children and the elderly. Pneumococcal vaccine will prevent pneumonia and meningitis among others while the rotavirus vaccine will prevent diarrhoea among children. The flu vaccine, which will be given to both children and the elderly, will prevent seasonal influenza.

Vaccinations save lives and for the last 39 years, the health ministry has been providing 11 vaccines to children, saving lives and enhancing the health of the population.  The health ministry must be commended for introducing the new vaccines and for sustaining the immunisation coverage at 97 percent.

The people need to know that these vaccines and essential drugs incur costs, which is today borne by the Bhutan Health Trust Fund. Recently, the cabinet asked the civil service commission to study its proposal of delinking the trust fund. The people must also know that delinking the trust fund from the civil service is a condition set by the Asian Development Bank for the USD 10 million grant it has committed.

Understood this way, the issue is more than meeting the costs of drugs and vaccines. It reveals the way donors are influencing national policies, an unhealthy practice that Bhutan may have normalised. The issue has become political as well. For in 2016, the prime minister announced that health trust fund will be doubled from Nu 1.5 billion (B) to Nu 3B by the end of this year. Health trust fund officials had then said that the prime minister’s pledge would be fulfilled as per the projected growth of funds post 2018, which includes Nu 650M from the ADB, and an endowment of Nu 500M from the government.

The intent to increase the trust’s fund may be virtuous. But to make political pledges and to fulfil them allow donors to influence national policies raises serious concerns on governance. Control of financial resources, studies have found, is the most common method by which donors influence policy implementation. Perhaps, it is because of our dependence on donors that mental health has not received much priority in the country. The civil service commission must thoroughly study the rational and nuances involved in the government’s proposal to delink the institution.

People appreciate the health ministry’s plans to enhance access to better health care facilities. It is​,​ however, troubling that the ministry appears to be faltering in executing some of its projects. Contractors have cried foul in the construction of the mother and child hospital, which resulted in the tender being floated thrice. In Tsirang, a 40-bed hospital is constructed as 20-bed. Whether it is corruption or procedural lapses or any other kinds of oversight, these cases indicate a grave problem in the health ministry. The audit authority did a good job pointing out these lapses.

Given the importance of these projects and institution in delivering healthcare services to the people, it is imperative that the ministry, besides berating the media, resolves these issues at the earliest. Public health is as much about gaining the confidence of the people as it is about ensuring their wellbeing. The people deserve answers. Shooting the messenger is not the answer.

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