COUNTRY BACKGROUND - Gross National Happiness Commission

Health Services
Table 13.4 Morbidity Patterns for Major Diseases as Percentage of BHU Cases (1985-19889)
13.13 Lack of hygiene and poor sanitation causes many infectious diseases. Diarrhoea and respiratory tract
infections remain by far the most frequent diseases treated by the health services. Worm infestations are estimated
to occur in up to 80% of the population. The majority of the diseases treated are seasonal and there is a marked
fluctuation in the out-patient department attendance between summer and winter. Nutritional deficiencies are an
important part of the disease pattern in Eastern Bhutan. A large proportion of the population suffer from gastric
problems such as gastritis, peptic ulcer and ventricular cancer due to dietary habits and consumption of doma (a
mixture of wet betel nut, paan (leaf) and calcium paste). Sexually transmitted diseases are also common among
some sections of the population.
Nutrition StatusNutrition Status
13.14 A nationwide nutrition survey was carried out between December 1986 and March 1988. It generated
information on the nutritional status of children up to 3 years and women between the age range of 15-45 years. It
was found that 56.1% of the children were small for their age and 37.9% of children were found to be underweight
for their age according to the WHO classification.
13.15 In the same survey, 13.8% of women examined were found to have Body Mass Index below 18.4 indicating
a serious calorie deficiency. Vitamin A and iodine deficiency and anaemia were also found to be unacceptably
high.
C. ConstraintsC. Constraints
Poor Sanitation and HygienePoor Sanitation and Hygiene
13.16 The existing morbidity pattern shows a high prevalence of respiratory infections, diarrhoea and worm
infestations. The incidence of these diseases can be minimised and prevented to a large degree by improving the
water supply system and promoting sanitation and hygiene. A change in personal hygiene would make a
considerable impact on the health of the population.
Remote and Scattered PopulationRemote and Scattered Population
13.17 Because the population is scattered, with an undeveloped road network, the District and Regional level
health facilities are fairly unaccessible to the majority of the people. These factors also make the cost of health
delivery very high. In most remote areas, the modern health services are sought as a last resort, resulting in
diagnostic and therapeutic delays. A delay and in some cases failure to demand health services leads to insufficient
utilization of existing health services. The effectiveness of modern health services is thus reduced.
13.18 The low literacy level, especially among women is thought to be a leading obstacle to the improvement of
the health status of most people. Giving high priority to the education of women is recognised as an investment in
health.
Shortage of Trained PersonnelShortage of Trained Personnel
13.19 As in most other sectors, the health sector is constrained by a lack of trained national staff. The Department
is dependent on expatriate personnel. Of the total DHS staff of 1019, 283 were expatriates in 1991.
II. Review of Past PerformanceII. Review of Past Performance
4
Disease 1985 1986 1987 1988 1989
Diarrhoeal disease 18.3 17.5 15.6 15.0 15.2
Respiratory disease 16.6 16.5 16.7 18.2 19.5
Worm infestation 11.6 11.7 11.0 12.9 10.0