Health Sector Development In Bhutan: Improving Disease Detection

Project Result / Case Study | 6 January 2020

Pandemics, of which some of the deadliest have originated in Asia and the Pacific, have to start somewhere. Detecting and treating disease near the source and early on can swiftly curtail the potential spread and growth of human suffering and economic loss across a country, a region, and sometimes the entire world.

Namgay Lhamo knows how a lack of adequate medical facilities, equipment, or standards locally can have regrettable repercussions abroad, even though these were more harmful to her family in their financial effects and opportunity loss than in medical terms.

Preparing to study in Singapore, Namgay’s 23-year-old son visited Bhutan’s Dorji Wangchuck National Referral Hospital, one of three referral hospitals in the country, for a medical exam. “He was declared clear of tuberculosis,” says the 56-year-old mother of six from the capital city, Thimphu. A Singapore medical check-up found differently, and the would-be student was forced to go home. “He lost half of his tuition fees, plus we had to buy a new plane ticket.”

Bhutan is one of many ADB developing member countries at high risk of disease outbreaks that without early detection could spread beyond its borders and add to the thousands of lives and hundreds of billions of dollars already lost annually to international pandemics.

The dangers have escalated worldwide with new and mutating pathogens, the emergence of antimicrobial resistance, and the expansion of vector ranges as climate change progresses.

Bhutan received $13.3 million from the $52.8 million grant facility set aside under Asian Development Fund (ADF) 12 for projects and programs related to regional health security because its health information management systems need improvement and its technology and data standards vary widely.

The Health Sector Development Program, supported by the ADF facility and additional ADF grant funding for a total of $20 million, is improving primary health care delivery and information systems. It is also upgrading the country’s disease surveillance systems and policies to help Bhutan and the region prepare for and manage pandemics.

“We have no choice other than the referral hospital right now. It will be really helpful to have a good, well-equipped health center closer to home.”

Tsamchu, hospital outpatient

The program will build on Bhutan’s impressive health outcome gains in recent years—including a sharp rise in life expectancy from 43 years in 1985 to 70 in 2017 and a child immunization rate of more than 95% sustained since 2010.

Five satellite clinics to be built on the outskirts of urban areas and the upgrading of existing primary health care facilities with better equipment will make the country better able to diagnose, treat, and control infections by easing the burden on staff and facilities at the national referral hospital in Thimphu and bringing health care closer to the people.

One target is to boost the percentage of people using primary care facilities as their first option from 32% in 2012 to 60% by 2024. Another is to raise the portion of the country’s health facilities reporting notifiable diseases to the National Early Warning, Alert, and Response Surveillance System to 80% by 2024 from 63% in 2018.

These improvements, and reforms to finance vaccines, are in line with ADB’s overall ADF backing for regional health security.

The program’s medical upgrades will provide sound benefits within Bhutan’s borders as well. For example, the problems faced by Namgay Lhamo’s son didn’t end with his return from Singapore.

“He went back to the national referral hospital afterwards,” says his mother. “He needed further tests and treatment for his tuberculosis, but the machine required was broken. It’s frustrating when your child is sick and getting worse and he can’t receive the proper care.” The family paid to use a private clinic.

The expansion and upgrades of primary care facilities under the ADF program will ease the current pressure on the hospital and the frequent delays in diagnosis and treatment, says Gosa Pemba, its 57-year-old medical superintendent. “People with less severe illnesses can be cared for at the new clinics. That will give doctors here more time to do and complete quality work.”

The new satellite clinics will be closer, easier, and cheaper to visit than the national hospital for many, including the poor. “We have no choice other than the referral hospital right now,” says 72-year old Tsamchu, who lives in Kabesa, 20 kilometers away. “It already costs us $7 to get there, and the other health clinics are even farther away. It will be really helpful to have a good, well-equipped health-care center closer to home.”

Learn more about the Asian Development Fund (ADF).

This article was originally published in Together We Deliver, a publication highlighting successful ADB projects across Asia and the Pacific that demonstrated development impacts, best practice, and innovation.