COUNTRY BACKGROUND - Gross National Happiness Commission

Health Services
13.34 Tuberculosis remains a major public health problem: the prevalence rate is estimated at 16 per 1000 people
of which 4 per 1000 people are infectious. The target for control of tuberculosis incidence is 1 per 1000 for both
pulmonary and extrapulmonary cases by year 2000. The Department plans to sustain 100% BCG vaccination,
particularly among children. As a matter of routine, people who visit health facilities will be diagnosed for
pulmonary tuberculosis. Cases detected will receive short course chemotherapy and treatment for eight months.
MalariaMalaria
13.35 Malaria occurs widely in the southern belt of the country. Of all cases seen in Basic Health Units in 1989,
9.4% were diagnosed as malaria. Beside offering treatment for malarial patients, insecticide is sprayed in the
endemic areas. Unfortunately, morbidity and mortality has not decreased, probably due to the growing resistance of
the parasite. Therefore, control studies will be undertaken to test the relative efficiency of alternative preventive
measures. Mass seasonal spraying will continue along with the promotion of use of mosquito nets. Community
efforts will be mobilized to control mosquito breeding habitats.
Leprosy Control ProgrammeLeprosy Control Programme
13.36 The number of patients under treatment has been reduced from 3,000 in 1982 to 250 by 1991. Over the
years, the leprosy control programme has brought about a dramatic reduction in the prevalence of the disease. A
number of leprosy hospitals have been managed by Leprosy Mission and Santal Norwegian Mission in
collaboration with the Department of Health Services. It has been run as a vertical programme, but it will be
integrated into the primary health care system. In 7FYP, the target is to reduce the prevalence rate to 1 per 1000 and
to complete multi-drug therapy course in 95% of all known cases and give multi-drug therapy to 90% of new cases.
Both an active case-finding and a rigorous surveillance of treated cases will be maintained so that the case detection
rate is close to actual incidence. All health workers will be trained in a basic core curriculum on leprosy.
Non Disease ProgrammesNon Disease Programmes
Population PlanningPopulation Planning
13.37 Population planning can have considerable influence on the success of all other programmes in the health as
well as other sectors. For example, in the Renewable Natural Resources Sector, limited arable land is a major
constraint to increasing food production which is necessary for a rapidly expanding population. Thus the proposed
programme's objective to decelerate the growth of population below 2% by year 2000 will permit sustainable
development in the agricultural sector. The programme will popularise the use of contraceptives and supply
sufficient quantities of contraceptives to all the Dzongkhags. Other measures will include promotion of breast
feeding, maintenance of health camps, introduction of social incentives for small families and raising the legal age
of marriage. The major thrust of this programme is to achieve proper spacing.
Essential Drugs ProgrammeEssential Drugs Programme
13.38 The Essential Drugs Supply Unit in the Department of Health Services is responsible for all drugs supplies
to the health sector. The objective of essential drug supplies programme is to make available at all times an
adequate supply of safe and effective drugs of acceptable quality and at a reasonable cost. A standard list of drugs
with 253 items have been selected, and all tiers of the system are regularly provided with adequate amounts of
drugs. The District Hospitals are supplied with 198 different drugs, the Basic Health Units with 91 and the Village
Voluntary Health Workers with 10 different drugs. Based on a National Drug Policy, rational drug prescribing
practice will continue to be promoted and monitored. National competence in drug management will be developed
by training and retraining health workers. A Drug Control Administration Unit will also be established in the
Department of Health Services.
Expanded Programme of ImmunisationExpanded Programme of Immunisation
13.39 An immunization coverage of 85% was achieved in 1990. Universal Child Immunization was thus,
declared on 13 February 1991. This high coverage in immunization will be sustained at a national level for
children under one year of age. Other targets are to eliminate neonatal tetanus by 1995 and poliomyelitis by 1997.
Deaths due to measles will also be reduced by 95% by the end of the plan. To keep up the momentum that has
been gained, the network of logistical support, vaccines and cold chains will be improved.
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