Almost 40 percent of the Bhutanese population has at least one form of non-communicable disease (NCD) that includes hypertension, diabetes, high cholesterol, alcohol-liver disease and tobacco-related diseases. NCDs are a major public health concern accounting for an estimated 62 percent of the disease burden in the country. According to health officials, deaths from NCDs increased to 69 percent in 2018 from 53 percent in 2011. Among them, 53 percent died before 70 years.

Health Secretary Dr Ugen Dophu said that if the public does not follow the health advisories, the percentage would drastically increase as the country is in an early stage of demographic transition.

The World Bank’s Bhutan NCD policy brief estimates that by 2025, the country’s proportion of the ageing population (65 years and above) is expected to increase from 4.4 to 7.3 percent.

This means that the prevalence of NCDs would also increase with the growing aging population, putting significant pressure on the country’s healthcare cost.

The health ministry’s message is simple, said Dr Ugen Dophu. “Eat healthy diet that includes lots of fruits and vegetables.  

Control salt and carbohydrate intake, practice physical activities and avoid using alcohol and tobacco products.”

The secretary said that the current pandemic besides causing major disruptions globally has also come as an opportunity for Bhutanese to practice a healthy lifestyle.

“Maybe it’s due to the fear of Covid-19, physical activities are increasing among Bhutanese,” he said.  “We can see people, young and old going for walks, cycling and indulging in various kinds of physical activities including yoga.”

He said although indoor gyms are currently closed to the public, it would not have major health impacts, as many would perceive. “The health ministry does not encourage people to go for bodybuilding. As long as they engage themselves in some sort of physical activities to keep their bodies healthy, that should be enough.”

Essential services  

Dr Ugen Dophu also reminded the public, especially those with health conditions including NCDs to avail the regular health services as usual. “We have not stopped providing any of the essential health service at the hospitals.”

In the initial days when the country saw its first Covid-19 positive case, he said that certain hospitals had stopped providing some of the essential services like dental care and ENT services.

The ministry has developed a guideline for essential health services that would be available to the public based on the pandemic stage of the country.

Under the current stage, Orange stage, where there are multiple confirmed cases in quarantine facilities with no local transmission, the secretary said that there would be no major disruption in the delivery of normal services including the outreach services.

The consumption of medical supplies by the Covid-19 activities would be tolerated with the existing buffer stock. The buffer stocks for vital, essential and necessary supplies are maintained at 30, 20 and 10 percent respectively.

The ministry has divided the Red Zone conditions in two stages. A Red Zone with community transmission in localised areas including lockdown of dzongkhags, gewogs, and villages will see a slight disruption in providing routine health services.

As health facilities start facing shortage of health workers and medical supplies, services like ENT and dental involving aerosol/oral nasal procedures would be cancelled. Elective surgeries would be reduced by 50 percent and patients would be attended on an appointment basis.

Once the country enters stage two of the Red Zone with massive local transmission, only emergency services would be provided. All elective surgeries would then be postponed including scaling down of essential health services.

Dr Ugen Dophu said that the guideline was developed to guide all health facilities to make a uniform decision based on the status of the country. “This has been prepared based on scientific reasons and the WHO guidelines on what needs to be shut down at what stage of the pandemic.”

For now he said anyone who requires health service can visit the hospitals.

Meanwhile, to further support the efforts of the health ministry in providing essential health services amidst the pandemic, the World Health Organisation (WHO) country office contributed NCD kits worth Nu 3.5 million (M) yesterday.

The NCD kits are a pre-packaged set of essential medicines and equipment for 20,000 people that would last for three months in emergencies, when medical facilities and regular supplies have been disrupted. It contains oral medicines, basic diagnostic equipment, renewables and additional products needing cold chain such as insulin.

WHO also handed over more than Nu 32M to help the ministry enhance the national preparedness and response against Covid-19 and to procure laboratory equipment and reagents.

WHO representative to Bhutan, Dr Rui Paulo de Jesus said that while the current focus is on Covid-19, the health ministry has ensured that essential services are not neglected.

He said that the WHO and the UN family in Bhutan would continue to support the government and the health ministry in their response to the current pandemic, and also to ensure all essential services made available to those who need it.

“I would like to commend the government for their success so far in handling the pandemic very professionally,” he said. “However, the fight is not over and we need to continuously identify the gaps, and if any, take timely remedial actions.”

https://kuenselonline.com/no-disruption-in-delivery-of-essential-health-services/