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Annual Health Bulletin-2004.Pdf ROYAL GOVERNMENT OF BHUTAN MINISTRY OF HEALTH THIMPHU : BHUTAN ANNUAL HEALTH BULLETIN 2004 Table of Contents General lnj'orllflltion Foreword .1 Map showing health infrastructure 2 Structure of the Health Ministry 3 Health <:~ S;vst~ ~<l Ftef~s 4 Health Manag~ent Information S;vstem flow chart 5 Demographic ~<l population in<licators 6 Health human resource & facilities 7 Fto;valInstitute of Health Sciences (IUHS) 8 Quality Assurance & S~dards for Health Services ~0 Department of Medical Services Institute of Traditional Meciicine Services (ITMS) 15 Laboratory Services ..............................................................•. 20 Infection <:ontrol & Hospital W aste M~agement 25 Nursing services 28 Primary E;ve <:~ 31 Oral Health Programme 34 Ftaciiological services 36 Telemeciicine 38 Worl<l Diabetic Founciation 41 Magee Project 42 Department of Public Health Fteprociucti"e Health ~<l J>opulation 45 Exp~<leci Programme on Immunization (EJ>I) 58 National Tuberculosis <:ontrol Programme (NT<:J» 61 Acute Ftespiratory Infection Programme (AFtI) 65 <:ontrol ofOiarrhoea1 Oiseases Programme (<:00) 68 Village Health Worker Programme (VHW) 70 National SID/AIDS <:ontrol Programme 73 National Lepros;v<:ontrol Programme n NationaI.Malaria.<:ontroI.Programme.(NM<:J» 78 Mental Health "Programme 83 <:ommunity Baseci Ftehabilitation Programme (<:BFt) 86 Annexures I. Annual Acti"ities Fteport for Hospitals ~<l BHUs 91 II. Health infrastructure b;V<listrict ; .104 ill. Hospital ~<l BHU Morbi<lity J>attem 108 IV. Abbre"iations .115 rGreVfJlEffYPJ R II1J1lf([J) ff1J1J1J (J)J it~([J)1J1l This Annual Health Bulletin, 2004 is the 24th in the series of publications brought Qut regularly as a media on Bhutan health services ..It is a source of basic information on health services delivery system recorded routinely and compiled on annual basis. This publication selVes as a periodical progress report and provides feedback on the ongoing activities of programme implementation. It is also intended to facilitate effective monitoring of health programmes and ensure appropriate interventions for better management of health services. Traditionally, this publication has therefore been our humble attempt towards meeting the basic requirements of data and information for planning and setting priorities in health. To make this system an effective tool, constant efforts are being pursued to improve it through appropriate and timely reviews. However, we would still require continued co- operation of all interested readers, particularly within health, in providing us feedback with comments and suggestions for further improvement of this bulletin. Looking back at the progress of health activities during 2004, considerable improvement has been observed. This is evident from the fact that one can see an increasing coverage of health services as revealed by the disease patterns over the years. There has been very little or minimum cases of any disease outbreak this year and that the risk of deaths or mortality has declined significantly. It is also observed that the attendance at the outpatient services is significantly on the rise. This may be attributed to the ongoing health awareness campaigns effectively reaching the grassroots and 'as a result the general population is becoming much more aware of their own health needs, thus seeking care. However, it is also evident from the records that problems do persist in many areas of health that need further attention. From both the global perspective and country situations, we are not only aware of the emerging problems but also seriously concerned with the rising trend of non-communicable diseases. There is also the challenge of preparing and managing disasters both man-made and natural. These altogether call for a closer look and require different strategies to tackle the situation in an environmentally friendly manner. In order to strengthen arid improve the district health system, the year 2004 has seen a major shift in the policy of health administration by introducing District Health Officer (DHO) who will manage overall public health aspects in the community. However, only 3 regions have been identified at the initial stage viz, Trashigang, Zhemgang and Chhukha for East, Central and the Western regions respectively. This change is expected to bring about improvement in the quality of services through fulltime involvement of the current DMOs in their clinical profession and not having to deal with administrative burdens. In conclusion, let me express my appreciation to all those who are involved in health services development in Bhutan. Our deep gratitude is due to the development partners, government agencies and to the health workers for their dedicated services whose collective efIorts have been a source of inspiration for health in creating a conducive and progressive life for the Bhutanese people. Secretary Ministry of Health lE::8E:f.lO a 1>1'(0081R"'ofi"ill ~ospiiQJ 113 Fqglon 8lllororr;l' HollP~II.l + H<mpitl>1 ~ 8tt:1ic He Ilt'l UJlir!JlilOO -I t). I)~\C; Heoalln Ul'1il m 1nt10enaU3 HnspUal LIlfr.* * fndl9BnOJ& U IVI ~r.lilll 0 -0 •• Malaria CllIltfa G A 5 A - Dzor.gllJl~Soundal)o' --lnllllmaliOr.e1 BoundDry t.. ! ______I__'T__ll__o__it t--·-·-·-·- __ B_h_u_ta_n_M_ed_i_ca_I_&_H_e_al_th_C_o_un_c_il __ 1 Centrall Dzongkhag Support Traditional Medicine Procure - Procurement &; ment. & Store distribution Regional, Training Centers .•. Programs, PP.C, On"lI •• th. Diabclei, Inrection Control & OthCR, •••. Wlcare, Hvo. MaR'C Projecr. f)(lmchu. JIJllilUriOlftfI 1II«4ffll;$1f£I National Referral Hospital Outside JDWNRH Bhutan , T ••• ••• Eastern Region Central Region Western Region Referral Hospital Referral Hospital Referral Hospital Mongar Gaylephu JDWNRH, Thimphu L _.1 Dzongkhag Hospitals (District Hospitals) Community Health Units :......................................... t........................................ : Basic Health Units ( BHU) Outreach Clinics (ORC) ......... .... Health Management Information System (HMIS) Flow of Information INFORMATION 1. National Level Indicators Health Staff information MANAGEMENT 2. Health Bulletins from Personnel Section of ••• Health, MoH . calculat~ I Produces / 1. Monthly/Annual data 1. Staff aggregated at BHU ~/ Database HEALTH level in electronic fom1 2. Vital statistics INFORMATION (by the end of next database UNIT month of past quarter)"- 3. Service Statistics 2. Intra-district personnel database transfer information 4. Facility Codes 1. Feedback rep0l1 (quarterly) (immediate) 2. Other infonnation on demand 3. District and lower level disease outbreak 1. BHUIHOSP infomlatioll Service Statistics database (immediate) \ DISTRICT 4. Other immediate 2. HOSPIBHU wise OFFICE household renarts (DHSO) intonnation 1. Monthly Activitv 1. Feedback report (Quarterly) ''A District level Report 2. Other infonnation on demand mdicators 2. Monthly Morbidity report 3. Immediate Monthly BHU reports (by 15tl·'of next month) Village Level Arumal Household Survey (by] 5th of March) / Immediate reports on notifiable dIseases [HOSP-IT~.~AJ-~-- Community Health Unit* Calculates ! Some BHU level BASIC HEALTH UNIT ----------------~ mdlCators (BHU) BHU Collects ORC service BHU Collects Vlllage mfonnatlOn informatlOn through annual survey & rural water supply inspection reports / [iRes fVote: Some "enical programmes (e.g. TB and Lepros}) reports are directly sent to respecti,'" programme head quarters. • Community JIcalth UnU (C"HU) sends same informatioll to DHSO as sent by BNUs. Morbiditv dl1/afrom CIIUIORCs managed by hospitals are added to the hospital l/wrbiditl ,[a!{/... i~~~~~~~7trtt;~1f~~~~~~J~~'~'f;~-.:;"~~~~7[.~~~~it't:~·~m~~~,:~-~-~~=~~~}~~~~~~;;:rf~1:9.:i'i#:::·;:}::,?~~,It:.'-I! ,t •• :.-..""~""l:rr t, -pl.1. f •• d '1 ••\.~, ••t ,1\:. -:~-l~~:;' - '.It •• i. ~+~"1-"';'; . 1 _t..~\. l ¥i!.ll·tlJl.jJ'l"J"l.J"b!"l.\&'lttt~1t;it{~j;~~.r. .• ;.•;";.J;j':.ltti ~._~_ri*.;:r~:;:-~ ,z;2.t"::':"n·1;;·'~-~·"--· .- ';:- _ ~r· .'. '''t .-r:~t'C.·~..•i ," ~ '.\1, r .-... .'I~h·~~~~"""·~"..~•..jd~·....=;t';f"~.ft!~l.lr- j-t:t:::~i~:~~f..::tif; ~:ft~J1a~~l:1fa;ffi ~~~~~;;~1r~~~~tt-t"tt ~~-:::2~~;~~~~~:I~~~*~~~4:L~h~~1Ul4;/j~{J~~ Population 56205 63890 ,8847 Male 27747 30440 33489 Female 28458 33450 35358 Life Expectancy at birth (years) NA 66.1 66.1 Sex ratio (Males per 100 females) 103- 105.1 106.6 91.7 77.4 Dependency ratio 80 - General Fertility Rate 170 172.7 142.7 Total Fertility Rate NA 5.6 4.7 Crude Birth Rate (per 1000 population) 39 39.9 34.1 Crude Death Rate (per 1000 population) 13 9.0 8.6 Population Growth Rate 3 3.1 2.5 Infant Mortality Rate (per 1000 live births) 103 70.7 60.5 Under-5 Mortality Rate (per 1000 live borths) 162 96.9 84.0 Matemal.mortality ratio (per 1000 live births) 8 3.8 2.6 Trained Birth attendance (%) NA 10.9 23.6 Health facilities and manpower, 2004 A. Human Resource Number of doctors (including non-nationals) 135 Doctors per 10,000 population 1.8 Ratio of doctors to hospital bed 1: 8 No. of Drungtshos (Indigenous physicians) 31 No. of sMen as (Indi enous com ounders) 26 District Health Supervisory Officers (DHSO) 23 RSc. Nurses 12 General Nurse Midwife/Staff Nurses (GNM) 183 Auxiliary Nurse Midwife (ANM) 140 Assistant Nurses 175 Health Assistants (HA) 201 Basic Health Workers (BHW) 171 Ratio of nurses to hospital bed 1:2 Nurses er 10,000 ulation 6.8 Lab. Technicians 106 Dental TechnicianslHygienist 48 X-Ray Technicians 32 Pharmacy Technicians 79 O.T. Technicians 23 Eye Technicians 29 Other Technicians 29 Compounders/Para medical workers 22 Malaria
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