Number of nurses and health assistants, meanwhile, have multiplied
Health: Policy response failure and poor human resource planning was statistically diagnosed for causing the number of doctors to remain stagnant in the country.
That the number of doctors has increased only by 40 between 1987 and 2011 in Bhutan is a peculiar situation for a country where “everything” has increased, an analysis on health’s data by the Center for Bhutan Studies concluded.
“What is so obviously a policy response failure is the stagnant number of doctors in this country,” center’s president Dasho Karma Ura told health officials in Thimphu on December 28. “Hence, I don’t know whether the services, in very complicated terms, have improved at all because the number is the same.”
The center’s analysis on social dimensions of health and wellbeing was presented to equip health planners in drafting their programs and interventions for the 11th Plan.
Dasho Karma Ura said the results of the GNH survey may confirm what the ministry needs to do and possibly bring into view, factors that are important for health but which are not considered important for planning.
Health’s infrastructure has remained stable after hydropower development in the late 80s led to an increase in the number of health care facilities.
The center feels there is more expansion happening within the hospitals today than on creating new hospitals. “Its now unresponsive even though the disease pattern is changing,” he said.
From 11 hospitals in 1974 to 27 in the late 80s, the number of hospitals in the country was 30 at 2011.
But, unlike for the doctors, Bhutan’s number of nurses and health assistants has multiplied over the years. From 85 health assistants in 1987, the number has increased by almost five times, to 408 in 2011.
There were 723 nurses last year, which was 273 in 1987 but unlike in other years, Bhutan saw a sharp increase in nurses in 2001, 2010 and 2011. “Has it to do with the management or outbreak of diseases or arbitrary decision of the minister, we don’t know,” Dasho Karma Ura said.
Health minister Zangley Dukpa said it was important to know how the ministry should go forward and see what rights and wrongs, they were doing. “The number of doctors shows how poor we are in planning,” lyonpo said.
The survey also revealed that 53.4 percent of the population rated their health status as very good, 20.3 percent as excellent and 18.4 percent as good.
While admitting the ministry may not have done well in planning for doctors, medical services department’s director general Dr Ugen Dophu explained the increase in number of health assistants and basic health workers meant the ministry was focusing on its primary health care approach.
“Over all it’s a very good planning because we were concentrating more on health promotion and disease prevention,” Dr Ugen Dophu said, correlating it to the health status findings.
While lack of consistent data and history did not allow the center for an in-depth analysis, Dasho Karma Ura said the survey findings revealed that those who are heavily under stress have the strongest idea of suicides.
“But on average 40 people commit suicide in this country and this is also a matter of public health,” he said. “My suspicion is, it’s younger females who are increasingly committing suicides.”
The highest number of suicides, 58, was reported in 2001 in Bhutan. It was 53 in 2008.
An expatriate volunteer with the health ministry Dr James said the figure was still low with the ratio coming to 5.7 per 100,000 population while Sri Lanka has 46 and Australia has 12.
“But it’s also very important to find out the sub groups,” he said adding the figures might be missing on overdose and single car accidents, which could be used as means for death by some.
Dasho Karma Ura, however, said the rate of suicide at an international level was not alarming. “But because of our approach to GNH, the room for such things should be very low,” he said. “Then, there is no claim for us to boast of GNH and we have not done better; in our case people should not be committing suicides, and for us it’s not about statistics, but about what we should be doing.”
That about two percent of the households is single member households indicates how the society is shrinking very quickly into single generation households, the center said.
“We claim that Bhutanese are large and multigenerational, but if we look at these numbers, then this claim is very weak,” Dasho Karma Ura said. “It is because as societies move into urban direction, the number of people in a household gets smaller and that has health consequences such as depression, like in Japan.”
Mental health & monk body
A worrying finding was that the widowed, separated and divorced population, showed less excellence in health. In case of mental wellbeing, it was the widowed group, who were found to be “substantially” suffering from more “severe mental distress.”
When health status was surveyed by occupation, it was always found the monks and gomchens (lay monks) who declared as not very healthy.
“Its an uncomfortable result and I am inclined to believe that it’s true because skin disease and piles affecting our monk population; their diet is very bad and discipline is very severe,” Dasho Karma Ura said. “Young monks are severely stressed may be because they are forced to memorise and may not be able to cope after very short hours of sleep.”
Psychiatrist Dr Chencho Dorji said those in the monk body and nunnery could suffer from poor health because most parents tend to enroll those children who are not physically able as monks and nuns.
Another puzzling yet significant finding was that all forms of disability were reported more among female children. Also, both disability and infant mortality among children is geographically concentrated in the east.
It was also found that the young population between 26-35 years is overweight and obese in Bhutan. Mongar and Trashigang have the highest number of over weight and obese population.
Bhutanese females work longer than men but sleep 12 minutes longer than men. On the day of survey, it was also found that 11 people of the 8,000 surveyed had not slept the night before. It was reported that they were up for funeral services.
Dr Chencho Dorji said it was time Bhutan thought seriously about time-use and of getting at least eight-hours sleep. “I believe eight hours of sleep is so mandatory for all,” he said. “But surgeons and doctors are also deprived of sleep and this is serious because pilots have limited number of flights because they can’t make an error. “
By Sonam Pelden