The health flagship prorgramme is going to cost a lot. The health ministry has projected a cost of Nu 1.9B (billion) for the four intervention or focused strategies under the flagship.
Of the total, about Nu 1.127B, the highest has been estimated for the prevention of cancers, which is one of the four areas of intervention of the flagship programme.
Chief programme officer with the health care and diagnostic division Tandin Dorji said the flagship is in compliance with the 12th Plan.
He said that due to budget ceilings, the ministry was not able to propose some of the priority activities in the 12th Plan, as there are many priority areas.
Tandin Dorji said focusing on early screening and diagnosis of preventable cancers would not only prevent morbidity and mortality from cancers but also be a cost-effective intervention that would reduce healthcare costs from referrals.
Gastric, cervical, oral and breast cancers are proposed as a target for prevention.
For the second strategy to provide specialised outreach camps to dzongkhags, a cost of Nu 55.54 million is estimated.
Currently, specialised care and treatment are available only at the three referral hospitals and a few other district hospitals.
Tandin Dorji said that patients from other districts have to travel to these centres even for routine procedures. “This strategy aims to send teams of specialists from the referral hospitals in their region to conduct specialised camps on a planned periodic basis, organised jointly with the districts.”
Conducting specialised camps, he said was not something new as the ministry has been doing it. “We want to expand this so we cover more services.”
The third strategy is rolling out the PEN Heart projects to other dzongkhags. Bhutan was one of the first countries globally to adopt the WHO Package of essential non-communicable disease interventions (PEN) programme.
The health ministry with the support of the WHO introduced people-centred care with PEN approach in Punakha and Tsirang in 2019.
Tandin Dorji said this was listed under the flagship so that the ministry can fund the activities to roll out to other districts. For this, health workers are required to visit households at least once every year.
“This could be done in combined with other activities like annual household survey, elderly care home visits, which would be cost beneficiary,” he said.
Improving the capacity of hospitals to reduce referrals is the fourth strategy. In this, the ministry will upgrade a few of the BHUs and improve human resource capacity, besides expanding services at the regional referral hospitals.
He said the major activity in this strategy was the provision of the medical equipment. “Every year, the ministry face shortages of budget for procurement of medical equipment.” The ministry will procure equipment for regional referral hospitals and district hospitals including the Emergency Obstetric and Newborn Care centres to supplement the regular procurement.
Patient referral both within the country and ex-country is a major burden on the health budget, he said. “It also impacts economic productivity due to loss of workdays for the patient as well as family.”
A total of 1,142 patients were referred to India at a cost of Nu 190 million in 2017 to 18.
One of the mechanisms of improving healthcare quality and reach is by upgrading strategic BHU IIs to BHU Is. After careful review at the ministry, the up-gradation of BHU IIs in Drujegang, Dagana and Nagor in Mongar to BHU grade I was approved.
For non-communicable disease outreach services and strengthening hospitals, Nu 70.89 and Nu 672.26 million were estimated in the flagship programme.
“We also have the HR requirement charted out in the flagship because HR is important for being able to implement the programmes,” he said.
Tandin Dorji said districts have a big role to play in the implementation of the flagship programme.
Most components of the flagship like planning of outreach activities, planning of camps, and reporting have to be implemented by the districts.
Lack of budget has always been an issue when implementing the activity in the district. With the flagship programme, the ministry will provide the fund and those at the district are required to implement the programme.
“It’s a big opportunity for us. We hope that through this project we can address a lot of health issues,” he said.