Health System and EPI Program

Bhutan's health care system is anchored by a network of 519 outreach clinics and 178 community health centers. There are district hospitals, three Regional Referral Hospitals and one National Referral Hospital.

At district and lower levels, district authorities provide administrative support for the system while the Federal Health Ministry provides technical support. The health centers report directly to District Supervisory Officers who compile the reports and submit them to the national level.

However, notifiable diseases, including HIV, and poliomyelitis, are reported directly to the national level through a separate active surveillance system.

The health centers provide promotive, preventive, curative and emergency services. The EPI Program was launched in 1979 with six antigens. In 1988 the National Assembly passed a resolution, which directed the Health Sector to immunize all children. Universal Child Immunization was achieved in 1991. Since then, Bhutan has maintained its vaccine coverage at levels above 85%.

EPI services are fully integrated into the general health services and vaccines are administered along with other maternal and child health and family planning services through the hospital and health center network. In addition, outreach clinics bring immunization services to remote communities.

Financing

Over the period 2006-2011, Gross National Income (GN) in Bhutan increased from 1350 US$ to 2070 US$ per capita, making it a GAVI-graduating country. Bhutan did not report expenditure data to the WHO/UNICEF-Joint Reporting Form (JRF) Database for 2010 and 2011. Government expenditures reported in 2007 suggests that  $815 was spent per surviving infant, a figure which is likely erroneous. Excluding the 2007 reported value, Bhutan spent an average of $51 per surviving infant from 2006-2009. Bhutan’s government expenditures on routine immunization ranged from $47 per surviving infant in 2006 to $26 in 2009.

Click to download Bhutan's 2006-2011 Reported Government Expenditures on Routine Immunization

View SIF's Interactive Expenditure Graph

Political Structure

In 2008, Bhutan adopted its first modern Constitution, codifying the institutions of government and the legal framework for a democratic multi-party system. The Constitution of Bhutan provides for a government consisting of three main branches – executive, legislative, and judicial – plus the officially apolitical Dratshang Lhentshog (Monastic Affairs Commission) of the Drukpa Kagyu state religion. The secular and religious branches of government are unified in the person of the Druk Gyalpo (King of Bhutan). See here a graphic representation. 

Bhutan's political system has developed from an absolute monarchy into a constitutional monarchy. In 1999, the fourth king of Bhutan created a body called the Lhengye Zhungtshog (Council of Ministers), headed by a prime minister. Executive power is exercised by the Lhengye Zhungtshog. Bhutan's head of government is the prime minister, nominated by the party that wins the most seats in the National Assembly and heads the Council of Ministers.

Legislative power is vested in the bicameral parliament, the upper National Council and the lower National Assembly. The National Council is the upper house, it is the subordinate house, and cannot author monetary or budget-related bills. Besides creating and reviewing Bhutanese legislation, the National Council acts as the house of review on matters affecting the security, sovereignty, or interests of Bhutan that need to be brought to the notice of the Druk Gyalpo, the prime minister and the National Assembly. The National Council consists of twenty-five members. Twenty members are elected by the electorates of the twenty dzongkhags, while five members are nominated by the Druk Gyalpo. The members cannot belong to any political party, and should have the minimum qualification of a graduation from a recognized university. The National Assembly is the elected lower house. The current National Assembly has 47 members, who were elected in the first ever general elections on March 24, 2008. Under the Constitution, the National Assembly consists of a maximum of 55 members directly elected by the citizens of constituencies within each Dzongkhag (District). (Art. 12) Under this single-winner voting system, each constituency is represented by a single National Assembly member; each of the 20 dzongkhags must be represented by between 2–7 members. Constituencies are reapportioned every 10 years.

Article 22 of the Local Government Act of Bhutan (2009) establishes Local Governments that are "decentralized and devolved to elected Local Governments to facilitate the direct participation of the people in the development and management of their own social, economic and environmental well-being." The stated objectives of all Local Governments are to ensure that local interests are taken into account in the national sphere of governance by providing a forum for public consideration on issues affecting the local territory. Local Governments receive financial resources from the National Government in the form of annual grants to ensure self-reliant and self-sustaining units of local self-government and to promote holistic and integrated area-based development planning. Local Governments are entitled to levy, collect, and appropriate taxes, duties, tolls, and fees in accordance with procedures provided for by Parliament by law.

Immunization-related Legislation

Section 21 and 22, Article 9 of the Constitution of the Kingdom of Bhutan provides that, “the state shall provide free access to basic public health services in both modern and tradi­tional medicines” and “the state shall endeavor to provide security in the event of sickness and disability or lack of adequate means of livelihood for reasons beyond one’s control”.

In 1997, Bhutan established its Health Trust Fund, to ensure continued and timely supply of vaccines and essential drugs, and to eliminate uncertainties for financing crucial components of the health services. It is currently capitalized at around $25 million. Proceeds are used to finance vaccines, vaccine equipment and essential drugs.

Program Activities:

• May 2012: SIF Director, Mike McQuestion and SIF SPO, Devendra Gnawali, carried out an introductory visit to Bhutan, as part of a joint mission with GAVI.