US embassy cable - 05NEWDELHI7417

UNCLAS SECTION 01 OF 02 NEW DELHI 007417 
 
SIPDIS 
 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: PREL, PGOV, PHUM, SCUL, EAID, IN, BT, NP, UN, Bhutan 
SUBJECT: BHUTAN: GOOD GOVERNANCE LEADS TO HEALTHY MOUNTAIN 
LIVING 
 
REF: NEW DELHI 7159 
 
1.  (SBU) Summary: Despite its isolation, low income and 
rugged terrain, Bhutan has created an effective system of 
state-provided medical care that is delivering a healthier 
population and outpacing others in South Asia.  The 
Government continues to invest heavily in the medical sector, 
with donor countries and the UN readily funding projects in 
Bhutan because government transparency, a lack of corruption 
and minimal legacy investments allows noticeable 
improvements.  Bhutan created a multi-tiered medical system 
consisting of 3 central referral hospitals, 26 regional 
hospitals and 158 local Basic Health Units (BHUs), along with 
a "telemedicine" program.  The Government is committed to 
women's health issues.  It has also dramatically increased 
the supply of clean water to its citizens, reducing the 
prevalence of water-borne diseases.  Bhutan has successfully 
eradicated polio and is on the verge of eliminating leprosy, 
but the spread of HIV/AIDS is a concern.  A Multi-Sector Task 
Force (MSTF) has been created to coordinate the fight against 
HIV/AIDS.  End Summary. 
 
A Free National Health Care System 
---------------------------------- 
 
2.  (SBU) Bhutan provides its citizens with free basic health 
care and has done an admirable job in extending this service 
to the farthest reaches of the country.  In its 2005 report 
"Situation Analysis of Women and Children in Bhutan," UNICEF 
commended the RGOB for creating an effective multi-tiered 
infrastructure that delivers widespread medical care at a 
reasonable cost.  Bhutan's medical system consists of a 
national referral hospital in the capital Thimphu, two other 
referral hospitals in central and eastern Bhutan, 26 regional 
hospitals in district headquarters, and 158 BHUs spread out 
over the countryside.  Donor countries and agencies reported 
that working in Bhutan is a "breath of fresh air" compared to 
most developing countries, because they actually see results 
for their efforts. 
 
The Basic Health Unit: Prevention is the Cure 
--------------------------------------------- 
 
3.  (U) The focus of the Bhutanese health program is 
preventative medicine, and the key to this effort is the BHU. 
 BHUs, employing a medical assistant, basic health worker and 
a midwife, are local medical centers accessible to the rural 
population.  UNICEF reported that 89 percent of Bhutan's 
residents were within a three hour walk of a BHU, noting that 
"given the very difficult terrain in most of the country, 
this is a striking achievement."  To push medical care out 
even further, there are 1,300 volunteer village health 
workers that provide initial diagnosis and triage to rural 
patients.  Essential drugs are distributed to each BHU and 
are free of charge.  The RGOB has demonstrated a strong 
commitment to women's health issues and UNICEF has documented 
that the BHUs have dramatically decreased maternal mortality 
ratios from 773 per 100,000 live births in 1984 to 255 in 
2000.  UNICEF pointed out that Bhutan's maternal mortality 
ratio remains high, due to the prevalence of home deliveries, 
because many Bhutanese must still walk for hours to reach the 
midwife at a BHU. 
 
Clean Water For A Healthy Life 
------------------------------ 
 
4.  (U) Another of Bhutan's major health care achievements is 
the provision of clean drinking water to its population.  The 
RGOB has increased ready access to water from 30 percent of 
the population in 1990 to 78 percent in 2000.  The coverage 
varies by district, with 65 percent access in the far-eastern 
district of Trashigang and 98 percent access in central 
Bumthang district.  The areas with greater water access tend 
to be in the mountainous areas with gravity-fed water systems 
and close proximity to a clean source of water.  UNICEF 
reported that most mountain streams are protected and provide 
clean water, even when untreated.  UNICEF told us that, 
overall, the water situation in Bhutan has much improved over 
prior years.  Many villages previously obtained water from 
local ponds, especially in the lower lying areas, resulting 
in widespread bacterial infections and disease.  The young 
were always hardest hit and it was not uncommon for large 
numbers of children to die during each outbreak.  Under the 
current water supply scheme, this no longer occurs. 
 
The Fight Against Disease 
------------------------- 
 
5.  (U) The RGOB has successfully eradicated preventable 
diseases through vaccination programs, with the World Health 
Organization (WHO) reporting immunization coverage at 99 
percent of the targeted population.  The Ministry of Health 
(MoH) confirmed that Bhutan had its last case of polio in 
1986 and is very close to eradicating leprosy.  The MoH 
indicated that HIV/AIDS is a growing concern in Bhutan, which 
currently has 72 confirmed cases, and the Government is 
taking the problem very seriously.  UNICEF and the MoH noted 
that, with the prevalence rate currently below 0.1 percent, 
Bhutan has a chance to avert an HIV/AIDS epidemic.  The RGOB 
has implemented an extensive campaign to combat HIV/AIDS 
under the direction of a Multi-Sector Task Force (MSTF).  The 
MSTF, which includes central, district and local governments, 
the private sector and NGOs, unifies prevention efforts under 
a single body. 
 
Telemedicine: A Modern Solution For An Ancient Kingdom 
--------------------------------------------- --------- 
 
6.  (U) The RGOB successfully extended basic medical services 
to small towns and villages with the BHU system, but cannot 
provide outlying areas with fully-trained doctors and 
specialists.  A lack of infrastructure and rugged terrain 
also make it difficult for patients to travel to central 
hospitals with specialists on their staffs.  To overcome 
these hurdles, the Government uses technology to improve 
access to health care through a telemedicine program being 
piloted in three hospitals in 2005, with plans to extend it 
nationwide by the end of 2006. 
 
Comment: International Assistance Remains Necessary 
--------------------------------------------- ------ 
 
7.  (SBU) The health sector provides another example of 
Bhutan's unique experience with trying to bring modern 
development to a centuries old Buddhist monarchy.  Bhutan is 
doing an admirable job extending health care to all its 
citizens, but has only been able to do so with international 
assistance.  Under Bhutan's fiscal policy, the government 
uses its revenue to cover current expenditures and grants and 
loans for capital expenditures (Reftel).  Therefore, while 
RGOB funds pay for ongoing medical costs, such as medicine 
and salaries, improvements such as new hospital construction, 
are still funded from abroad.  Without continued foreign 
assistance, further upgrades to Bhutan's health system would 
be delayed. 
 
8.  (U) Visit New Delhi's Classified Website: 
(http://www.state.sgov.gov/p/sa/newdelhi) 
BLAKE