BHUTAN is known as a country of medicinal plants with pristine foothills, snow-capped mountains and lush green forests. With her small population of about 700,000, Bhutan has a forest cover about 72% and is known for her environmental preservation. These forests have rich biological diversity with more than 7000 species of plants and 700 species of birds. Because of its geographical and biological diversity, traditional medicine has been in regular practice as a natural solution to natural problems. It formed a natural blend of culture and tradition in which Buddhism is prevailing influence. This holistic approach to health and well-being since the inception of traditional medicine in Bhutan, was in conjunction with the holistic developmental approach for the country.

Although there were instances of Bhutanese scholars being sent to Tibet to study medicine by the patrons, it was only when the founding father of Bhutan, Shabdrung Nawang Namgyal came to Bhutan in 1616, one of his religion ministers, Tenzing Drukda, an esteemed physician, started teaching (gSo-ba-Rigpa), the traditional medicine in Bhutan, in a monastic set up. The specific knowledge and skills gained by the Bhutanese over the centuries and the natural environment, which is rich in diverse flora and fauna, enabled development of traditional medicine and natural medical products which are unique to Bhutan.

The modern health care system in Bhutan was conceived in 1961 and an integrated health system was envisaged. The health system, similar to the British National Health System (NHS), was established, due to the influence of Her Majesty the Grand Queen Mother, Ashi Kesang Choden Wangchuck, who was educated in England and was a patron of many social development works in the kingdom. The traditional medical service was formally introduced in 1968 under the integrated health care delivery system. Human resource training for health began at the Royal Institute of Health Sciences (RIHS) in 1974, and in 1979 Bhutan formally adopted the PHC declaration of Alma Ata, although primary health care formed the backbone of the Bhutanese health care system long before the declaration. The rural and under-privileged population, even then, was given priority in the expansion of the health services.

The first five year developmental plan (1961-1966) set Bhutan on the way to planned national development with a strategic plan for all sectors, even as due emphasis was given to the social sectors such as health and education which are key components of the nine domains of GNH. This approach to the development of this small and unique nation, where ‘development’ is measured in terms of Gross National Happiness (GNH) and not Gross Domestic Product (GDP), has been the process adopted under the wise leadership of our monarch. The Bhutanese health care programme has evolved into a fairly efficient system with an emphasis on primary health care as the backbone of the system.

 

The Royal Government of Bhutan, recognizing health as a key component of socio-economic development, has embarked upon the expansion of health services over the past four decades. Today we have 29 hospitals, 176 basic health units (BHUs), 514 out-reach centres (ORCs) and 25 traditional medicine units in the country delivering health care to the people even in the remotest of areas. The nation has come a long way in terms of health infrastructure, human resource development and preventive health programmes. As a result, there are significant improvements in the health indicators. The life expectancy at birth has increased significantly since the 1950s, from 36.1 years to 63.5 years at present. Under-five mortality has declined from 108/1000 live births to 61.6/1000 live births and infant mortality has decreased from 185/1000 live births to about 40.10/1000 live births (United Nations Population Division, December 2007).

 

Although the term ‘health’ has been variously defined using different contexts, the WHO defines health as ‘a state of complete physical, mental, spiritual and psycho-social well-being and not merely an absence of disease or infirmity.’ The holistic model views health as being ‘a sound mind, in a sound body, in a sound family, in a sound environment’. GNH encompasses both the health of an individual and that of the society he lives in or belongs to. A nation or society cannot be healthy without healthy people. The growing acceptance worldwide of the concept of gross national happiness as being a viable alternative to development paradigm is testimony to many problems inherent in the traditional capitalistic and socialistic development philosophies.

Healthy people directly impact socio-economic development of a country through productive participation in economic activities, enhanced quality of life and improved standards of living. Therefore, it is only pertinent that the health care delivery is based on equality and equitable access to every section of the Bhutanese society on a sustainable basis. GNH cannot be achieved if every Bhutanese citizen does not have access to all levels of health care services, right from basic health care to life-saving or life-sustaining tertiary care within or outside the country. In Bhutan, these services are provided free to all people irrespective of social class, creed, race, economic status, ethnicity, and religious and political affiliations. With such access to health care, sustainability is a concern and one of the several measures taken to sustain health care financing is through the establishment of the Bhutan Health Trust Fund. The primary objective of the fund is to sustain primary health care through continued and uninterrupted supply of essential drugs and vaccines.

In order to strengthen equal and equitable access to health care, the government constructed several basic health units (BHUs) and outreach clinics (ORCs) across all corners of the country. The concept of voluntary village health workers (VHWs) has facilitated the promotion of health care further to the community and family levels. Bhutan is committed to further strengthening these important components of service delivery systems to ensure health as medium of delivery of GNH to the people. The initiative taken by government through establishment of the Bhutan Institute of Medical Science is envisioned to ensure that the remotest of the basic health units are manned by competent doctors and skilled health workers.

 

The Bhutanese psyche, the culture and traditional practices are all influenced by Buddhism, which is manifest in different traditional healing practices, spiritual rituals and beliefs, and a strong belief in compassion and peaceful coexistence with all sentient beings. Evolving from such spiritual and religious faith and practice, is the traditional system of medicine, known as gSo-ba Rigpa, which has played an important role in healing from well before the advent of modern medicine in the country. Because of the integrated health system in Bhutan, both these services can be accessed under one roof in district hospitals around the country. Traditional medicine has been tapped to address psychological well-being, one of the GNH domains, in addition to catering to the physical health care needs of the people. Integration of allopathic and traditional medicine as a holistic approach to health care, which Bhutan is practising since the inception of a health care system, is one of the ways to promote happiness among the people.

The main foundation of the GNH development paradigm is the concept of good governance, which will determine the final outcome of all our developmental interventions and strategies in the pursuit of Gross National Happiness. Therefore, it is critical to strengthen good governance in health care delivery systems to be one of the mediums of delivery of GNH.

The decentralization initiatives undertaken by the government in general and the health ministry in particular, are key to strengthening good governance across sectors, particularly in the districts such that the people are empowered to make decisions in relation to the management of health and human resources, formulation of development plans, implementation, monitoring and supervision processes. These mechanisms enable empowerment of the stakeholders and improve accountability in decision-making and implementation.

Gross National Happiness is a concept that had been there all along the development process of the country under the leadership of our dynamic kings, infused carefully into the traditions and culture of the nation. This approach to the health of the nation is one of the main contributors to GNH. The health system adopted by Bhutan is and will always be a strong medium for the delivery of Gross National Happiness.