Tuesday, February 26, 2013

Bhutan should not privatize health yet!

The people of Bhutan have been enjoying free health services till date. The health sector has always been one of the top priorities in the government plan and has always ensured that the people had free access to health care. While the standard of the medical facilities in the rural areas may not be up to the standard as seen in the developed countries, the aim of these basic health units are to attend to the basic health care services such as common ailments like cold, fever, water borne diseases etc. On this front, Bhutan has been performing commendably well and the Ministry of Health reports that the basic health coverage is 90 percent (WHO 2010). It also reports that, because of the free health care access, there has been a prominent decrease in the mortality and morbidity in the recent years with life expectancy at birth rising from 33 years in 1960 to 66 today. Moreover, there is a remarkable improvement on key health indicators, such as immunization coverage, elimination of leprosy and endemic goitre.

Despite these achievements, there are people who are unhappy with the services that the free medical facilities have been delivering. People complain of having to wait a long time to see a doctor and the inefficiency of the whole procedure of medical access. Recently, there have also been cases of hospitals going through drugs shortage (Kuensel 2012), thus rendering people to go home helpless after they had come all the way to the hospital, walking a long way from their villages. So, having said that, my argument is, should medical facilities in Bhutan be privatised in order to ensure prompt health services? I will argue that while it seems like a solution, it will bring more damage to the country than good by creating inequity and income gap, thus ruining the achievement the free health facility has brought so far.

Considering the situation of Bhutan where 69% of population lives in the rural areas (National Statistical Bureau 2005) depending on subsistence farming, it would be impractical to privatise the medical facilities. Moreover, 23% of our population lives under poverty line of Nu 1,100 per person per month (Nationals Statistical Bureau 2007).  Firstly, it would create a gap between the poor and the rich. For example, while people who can afford to buy sophisticated treatment can live better even when they are struck by serious sickness, people in rural areas may die from even curable diseases such as diarrhoea (Wangchuk 2007). One can observe this trend already. It is not unknown for people with high income to go for treatment to Bangkok or India at their own expense even when the treatment for that particular disease is offered for free in the country. Since they can afford it, they find it worthwhile to explore the better medical facilities that these countries offer. Analysing this scenario, I do not see the need to privatise the health care facilities in Bhutan with the aim to make their services more efficient or prompt because people who will want to access these private health facilities are already doing it. While, privatising it may mean keeping the economy inside the country, it will definitely create a bigger gap between the rich and poor. Furthermore, the doctors and specialists will then want to work in the private hospitals and clinics which offer better pay compared to the government hospitals. Consequently, the standard of the health care services in the government hospitals will go down and the problem of shortage of doctors and specialists will aggravate. This will then force even the people with low income to go to the private hospitals, which they will not be able to afford. Eventually, they will end up not getting the required treatment because it is not available in the government hospitals where it is free, and they cannot afford in the private hospitals where it is available.

For example, if the health care services in Bhutan were not free, I would have lost my mother who was diagnosed brain tumour and had to be referred to a hospital in India in 2008. It was because of this benevolent scheme of health facility in our country that she could be attended by the well experienced neurosurgeon that was beyond our affordability. One can imagine how many similar situations there would be in a country like ours where people struggle to meet ends meet every day. And one can well foresee what will happen to these people if their right to health is taken off by privatising it.

However, Dorji (2008) argues that the free health care services make people develop dependency and devaluation of services and the service providers develop a complacency hindering the provision of effective health care services. But research (for example Feynberg 2009) shows that privatisation is not the solution because as seen in the US, private health care does not ensure successful delivery of efficient and quality healthcare services.

So, it shows that currently many people in the country are not yet ready for privatisation of health care services. While the opening of the new clinic by Dasho Gado Tshering, former Health Secretary (Bhutan Broadcasting Service 2012), indicates that it cannot be prevented in the future, it is not yet time. Privatising it now will create a duel health system where the rich and poor are demarcated (Solution Exchange 2007). More importantly, Bhutan should first study and analyse the situation in the country, without jumping into plan by adopting methods in other countries and it should place specific regulatory measures and legal frameworks before taking such step.

Bhutan Broadcasting Service 2012, ‘Bhutan’s first private clinic opens’, Bhutan Broadcasting Service, 30 June, viewed 1 November 2012< http://www.bbs.bt/news/?p=14726>.

Dorji, C 2008 ‘Bhutanese Health Care Reform:A Paradigm Shift in Health Care to Increase Gross National Happiness’, Proceedings of the Fourth International Conference on Gross National Happiness, The Centre for Bhutan Studies, Thimphu, pp. 413-436.

Kuensel 2012, ‘How 96 percent was arrived at’ Kuensel, 28 April, viewed 1 November 2012 < http://www.kuenselonline.com/2011/?p=30488> .

National Statistical Bureau 2007, Bhutan living standard survey 2007, National Statistical Bureau, Thimphu, Bhutan, viewed 1 November 2012< http://www.nsb.gov.bt/pub/surveys/blss/blss2007.pdf>
National Statistical Bureau 2005, Results of population and housing census 2005, National Statistical Bureau, Thimphu, Bhutan, viewed 1 November 2012< http://www.nsb.gov.bt/pub/phcb/PHCB2005.pdf>
Solution Exchange Bhutan, 2007, Is Privatization the Answer to Quality Healthcare?  14 December, viewed 1 November 2012< http://www.solutionexchange-un.net.bt/(A(loykpedQzAEkAAAANGIzNDViY2EtODY4My00Mzk0LWIyYWUtZTliMDFlZGY5OTZm43B1xu75nuwlxNK2epkdbl6sCCU1))/ConsolidatedReports/cr-se-bhutan-05110701-1.pdf>
Wangchuk, S 2007 ‘Should health care in Bhutan be privatised?’ Kuensel, 20 September, viewed 1 November 2012< http://www.kuenselonline.com/2011/?p=739>.
World Health Organisation 2010, Country cooperation strategy at a glance, World Health Organisation, India, viewed 1 November 2012<http://www.who.int/countryfocus/cooperation_strategy/ccsbhutan.pdf>

Monday, February 4, 2013

I'm Home

When I had to take a very difficult subject in the final semester, I panicked that it might detain my return. When I chose my course, I wanted the duration to be 18 months because I thought two years was too long, and one year was too short. I didn’t want to be away from home too long. I am glad things did go as planned – at least this once. And now, I am home.

I missed my mother. I missed my country. But until the plane descended and I saw Paro Valley, I didn’t realize the intensity of how much I have missed home. I craned my neck and watched out the window, wanting to carve each small detail of the landscape in my mind:  clumps of clouds strewn overhead, the small isolated houses on the hill tops and down in the valley looked heavenly. I thought even the long zig zag footpaths that go to these houses have happy stories to tell.

A chill winter wind welcomed us home as we got out the plane. But I thought, ‘it isn’t as cold as I thought it would be.’ My brother and driver from my office welcomed us. My mother waited in the car. I went straight to her – she sat near the window, her eyes already wet. We hugged and I cried too. I felt an enormous gratitude (to the almighty) for bringing me and my family back home safe.

I am home. Yes, I am home. It is where I belong. No matter where I go, I will come back here. It is where my heart is.