Monitoring the health SDG goal: Indicator of overall progress - Bhutan

74.4 13.3% 86.7% Out-of-pocket expenditure⁴ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection. Bhutan Urban population² 40.9% Healthy life expectancy (HALE) Healthy life expectancy* (HALE) represents the average equivalent number of years from birth of living in good health without disease or injury. Males have 0.3 years longer HALE than females. Population (000s)¹ 772 Poverty³ 1.5% GDP per capita³ (Current US$) 3243.2 Current health expenditure as share of GDP⁴ 3.2% 0 20 40 60 80 Age (years) Male Female 60.5 60.8 Monitoring the health SDG goal: Indicator of overal progress (ppp <US$ 1.90 a day) 5.7% The goal of UHC is that al people and communities receive the health care they need, without sufering financial hardship. Monitoring UHC requires measuring health service coverage and financial protection (SDG target 3.8). Universal health coverage (UHC): At the centre of the health goal HEALTH SERVICES COVERAGE The summary measure of essential health services coverage, service coverage index of sub-indicators in four main areas: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 0.6% or approximately 4 578 people are being pushed into poverty (at US$ 1.90 level) because of out-of-pocket health spending.¹⁷ Catastrophic expenditure on health*: 1.8% of people spent more than 10% of their household's total expenditure on health care.¹⁷Family planning coverage⁶ Child immunization coverage⁷ (DTP3) Care seeking behaviour suspected pneumonia⁶ Pregnancy care (%) 0 50 100 Co ve rag e ( %) 9785 74 86 Reproductive, maternal, newborn and child health Latest available data (2010-2019) Tuberculosis (efective) treatment coverage⁸ HIV antiretroviral therapy coverage⁹ Access to at least basic sanitation¹² (%) Insecticide-treated bednets coverage 0 50 100 Co ve rag e ( %) 74 37 69 Infectious diseases Prevalence of normal blood pressure¹² Prevalence of normal fasting blood sugar level Tobacco non-use¹³ . 0 50 100 Co ve rag e ( %) 93 44 64 Noncommunicable diseases Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹⁴, expressed as % of global threshold, 44.5/10 000 Health security: IHR compliance¹⁶ - 0 50 100 Co ve rag e ( %) 97 21 73 Service capacity, access and health security UHC services coverage index of essential health services To provide a summary measure of coverage, an index of national service coverage is computed by taking the geometric mean of service coverage values across the sub-indicators. The UHC coverage index ranges from 0% to 100%, with 100% implying ful coverage across a range of services. 2010 2020 0 50 100 Co ve rag e ( %) 47 64 UHC services coverage index* Out-of-pocket expenditure, as % of the curent health expenditure (2017) Public spending on health⁴ is determined by the capacity of the government to raise revenues and the level of priority it ataches to the health sector. This profile provides an overview of the current status of progress towards the 13 targets under the health Sustainable Development Goal #3 (SDG3) plus other selected health-related indicators. Twenty-five of the indicators are noted with an asterisk (*), which Member States in the WHO South-East Asia Region have designated to be the most common indicators of importance for the Region. This profile also includes al of the SDG indicators for the WHO Thirteenth General Programme of Work 2019–2023 (GPW13) (N/A in SEAR region) , Quality of health care: cleaner and safer health facilities Maternal and child mortality (SDG target 3.1, 3.2) Births atended by skiled health personnel*⁶⋅¹⁸ 2000 2005 2010 2012 2017 0 50 100 Pe rce nta ge (% ) 97.0 23.7 49.1 64.5 74.6 Maternal mortality ratio*² 2000 2005 2010 2015 2017 0 150 300 450 MM R ( pe r 1 00 00 0 l ive bi rth s) 183.0 423.0 1990 2000 2005 2010 2015 2018 0 50 100 150 200 CM R ( pe r 1 00 0 l ive bi rth s) 29.7 16.4 127.4 42.5 Child mortality*²³ Neonatal mortality rate Under-five mortality rate SDG 3: Health targets ,,Communicable diseases (SDG target 3.3) New HIV infections*⁹ TB incidence rate*²⁴ 20142015201620172018 100 200 TB in cid en ce (p er 10 0 0 00 po p.) 185 165 193 145 149 Malaria incidence rate*¹⁰ 20132014201520162017 0 1 2 3 Inc ide nc e ( pe r 1 00 0 p op . a t ri sk) 0.2 0.4 3.5 2.8 2.8 Malaria incidence is calculated for confirmed cases Indicators Year Bhutan Regionalestimate Hepatitis B surface antigen prevalance among children under-5 years²⁵ (%) 2015 0.81 Number of people requiring interventions against neglected tropical diseases*²⁵ 2018 222 639 0.26 917 512 156 Regular electricity National Frontline service Vacancy rate Doctors Nurses Essential medicines available National Frontline service IPC commitee or focal point National Frontline service 73% 7% Efecive services Safe facility National policy on quality/safety of health care exists Yes National guidelines exist: Yes Partly No Surgial care Child birth Injection Medication Blood Medical devices Outpatient visit/ person/year3.5 of indicators aremonitored and reported50% Progress towards UHC wil be seriously constrained without improvement in the quality of health care Health careassociated infection rate Children prescribed antibiotics for common cold Antenatal care coverage (4 visits) Children with diarhoea received ORS or equivalent advice TB treatment success rate for new and relapse case Hypertensives are treated and controled ?% 30% 85% 81% 95% 3% Clean facility Basic WASH services at health facilities Data is curently unavailable More is beter Less is beter Curent data are insuficient to determine trend Indicators SDGtargetYear Bhutan Regional estimate Probability of dying from any of CVD, cancer, diabetes, CRD between age 30–70*²⁵ 3.4.1 2016 23.3 23.1 Noncommunicable diseases and injuries Proportion of maried or in-union women of reproductive age who have their need for family planning satisfied with modern methods 3.7.1 2010 84.6 75.3 Sexual and reproductive health Adolescent birth rate (per 1000 women aged 15–19 years) 3.7.2 2012 28.4 26.1 Total alcohol per capita (≥15 years of age) consumption (litres of pure alcohol) 3.5.2 2018 0.4 4.4 Age-standardized mortality rate atributed to household and ambient air polution (per 100 000 population) 3.9.1 2016 124.5 165.8 Mortality due to environmental polution Mortality rate atributed to exposure to unsafe WASH services²⁵ (per 100 000 population) 3.9.2 2016 3.9 Mortality rate from unintentional poisoning⁵ (per 100 000 population) 3.9.3 2016 0.6 15.4 1.8 Prevalence of tobacco use among 18–69 years old –Female 3.a.1 2014 13.6 Prevalence of tobacco use among 18–69 years old –Male 3.a.1 2014 33.6 – – Tobacco use DTP3 immunization coverage among 1–year– olds 3.b.1 2018 97 MCV2 immunization coverage by the nationaly recommended age*²⁵ 3.b.1 2018 91 PCV3 immunization coverage among 1-year-olds 3.b.1 2018 – HPV immunization coverage estimates among 15–year–old girls 3.b.1 2018 90 89 80 17 1 Essential medicines and vaccines 2000 2005 2010 2015 2016 0 25 50 75 100 Pe rce nta ge (% ) 21.9 24.928.833.1 Probability of dying from any of CVD, cancer, diabetes, CRD between age 30–70, by sex Female Male Demand for family planning satisfied with modern methods DTP3 immunization coverage among 1- year- old, by place of residence Total net oficial development assistance to medical research and basic health per capita²⁵ (US$) 3.b.2 2018 1.92 Proportion of health facilities with a core set of relevant essential medicines available and afordable on a sustainable basis (%) 3.b.3 2016 95 0.39 – Health worker density*¹⁴ (per 10 000 population) 3.c 2018 22.8 26.0 Health workforce Average of 13 International Health Regulations Core Capacity scores* 3.d 2019 59 61 National and global health risks Other health-related SDGs Domestic general government health expenditure as % of general government expenditure⁴ 1.a 2017 7.9 8.1 General government health expenditure Prevalence of stunting in children under–5* 2.2.1 2015 21.2 Prevalence of wasting in children under–5* 2.2.2 2015 4.3 Prevalence of overweight in children under–5* 2.2.3 2015 3.9 31 14.7 3 Child nutrition Prevalence of anaemia in women of reproductive age (15–49 years) 2.2.4 2016 35.6 45.8 Note: En dash (–) implies relevant data are not available Proportion of ever-partnered women and girls aged >=15 years subjected to physical, sexual or psychological violence by a curent or former intimate partner in the previous 12 months 5.2 2019 – – Intimate Partner Violence 201520162014201720132012 0 5 10 15 20 25 Pe rce nta ge (% ) 10.0 8.3 8.0 7.9 7.2 6.7 Domestic general government health expenditure as % of general government expenditure Suicide mortality rate (per 100 000 population) 3.4.2 2016 11.4 13.2 Road trafic mortality rate (per 100 000 population) 3.6.1 2016 17.4 20.7 Curent data are insuficient to determine trend Curent data are insuficient to determine trend References 1.World population prospects: the 2019 revision. New York: United Nations, Department of Economic and Social Afairs, Population Division; 2019 (htps:/population.un.org/wpp/, accessed 29 June 2019). 2. World urbanization prospects: 2018 revision. New York: United Nations, Department of Economic and Social Afairs, Population Division; 2018 (htps:/population.un.org/wpp/, accessed 29 June 2019). 3.World Bank. (htps:/data.worldbank.org/, accessed 28 May 2019) 4.Global health expenditure database. Geneva: World Health Organization; June 2019 5.Global health estimates 2016: Life expectancy, 2000–2016. Geneva: World Health Organization; 2018 (htps:/www.who.int/gho/mortality_burden_disease/life_tables/en/, accessed 29 June 2019). 6. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh, and Rockvile, Maryland, USA: NIPORT, Mitra and Associates, and ICF International. (htps:/dhsprogram.com/pubs/pdf/FR311/FR311.pdf , accessed 29 June 2019) 7. WHO/UNICEF estimates of national immunization coverage. (htp:/apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=BGD, accessed 29 June 2019) 8. Global tuberculosis report 2018. Geneva: World Health Organization; 2018 (htps:/www.who.int/tb/publications/global_report/en/, accessed 15 March 2019). 9. UNAIDS/AIDSINFO [Online database]. (htp:/aidsinfo.unaids.org/, accessed 29 June 2019) 10. Calculated. World Malaria Report 2018. Geneva: World Health Organization; 2018 (htps:/www.who.int/malaria/publications/world-malaria-report-2018/en/, accessed 15 March 2019). 11. WHO/UNICEF Joint Monitoring Programme estimate 2015. 12. Tracking universal health coverage: 2017 global monitoring report 13. Global Adult Tobacco Survey data (GATS). (htps:/www.who.int/tobacco/surveilance/survey/gats/bgd/en/, accessed 3 July, 2019) 14. HRH profiles 2018 15. Bangladesh Service Provision Assessment (SPA) Survey 2014. (htps:/dhsprogram.com/pubs/pdf/SPA23/SPA23.pdf , accessed 29 June 2018) 16. International Health Regulations (2005) Monitoring Framework [online database], Global Health Observatory (GHO) data. Geneva: World Health Organization (htps:/www.who.int/gho/ihr/en/, accessed 21 March 2019). 17. SEARO staf estimates from (Bangladesh) Household Income and Expenditure Survey 2016 18. Bangladesh DHS Survey 1999, Bangladesh DHS Survey 2004, Bangladesh DHS Survey 2007 19. Calculated. Ministry of Health and Family Welfare. Health Buletin. Dhaka: Management Information System/ Directorate General of Health Services; 2017. (htp:/www.dghs.gov.bd/images/docs/Publicaations/HB%202016%20_2nd_edition_13_01_17.pdf – accessed 29 June 2019) 20. WHO. Global Health Observatory (GHO) (htps:/www.who.int/gho/en/ - accessed 29 June 2019) 21. Ministry of Health and Family Welfare. Health Buletin 2017. Dhaka: Management Information System/ Directorate General of Health Services; 2018. (htp:/www.dghs.gov.bd/images/docs/Publicaations/HealthBuletin2017Final13_01_2018.pdf22 , accessed 29 June 2019) 22. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva; 2015 (htps:/apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng.pdf;jsessionid=56B6C12830EA6EA8CD0F30A8433E8FC3?sequence=1, accessed 28 May 2019). See for Maternal Mortality Ratio. Country reported value: 2017=172; 2016=178, 2015=181, 2014=193, 2013=197 Data source: Bangladesh Sample Vital Statistics 23. Levels & trends in child mortality: report 2017: estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC): UNICEF, World Health Organization, World Bank, United Nation; 2017 (htp:/www.childinfo.org/, accessed 28 May 2019). See for under-five mortality. Country reported value: 2017=31, 2016=35, 2015=35;2014=38, 2013=41 Data source: Bangladesh Sample Vital Statistics. See for neonatal mortality rate. Country reported value: 2017=17, 2016=19, 2015=20, 2014=21, 2013=20.Data Source: Bangladesh Sample Vital Statistics 24. WHO Global Tuberculosis database [online]. ( htps:/www.who.int/tb/country/data/download/en/, accessed 29 June 2019). 25. World Health Statistics 2019. (htps:/apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf?ua=1, accessed 28 May 2019) 26. See for suicide mortality rate. Country reported value:2016=14.7 Data Source: 27 See for road trafic mortality rate. Country reported value: 2016=14.4. Data Source: Bangladesh Health Injury Survey 2016 28. See for Annual mean concentrations of the particulate mater (PM 2.5). Country reported value 2014=107, 2015=94, 2013=57. Data Source: Administrative Data taken from Ministry of Environment and Forest (MoEF) and Air Now, DOS Note: En dash (–) implies relevant data are not available Amount of water-and sanitation-related oficial development assistance that is part of a government-coordinated spending plan ad (constant 2016 US$ milions) 6.a 2018 19.32 1414.13 Proportion of population with primary reliance on clean fuel⁵ 7.1 2018 77 50 Clean household energy Annual mean concentrations of fine particulate mater (PM2.5) in urban areas²⁵⋅²⁸ (µg/m3) 11.6 2016 35.4 57.3 Ambient air polution Mortality rate due to homicide (per 100 000 population) 16.1 2017 2 3.9 Homicide and conflicts Birth registration coverage⁶ 16.9.1 2017 99.9 – Birth registration Completeness of cause-of-death data 17.19.2 2017 – 10 Cause-of-death data Indicators SDGtarget Year Bhutan Regional estimate Proportion of population using safely managed drinking water services 6.1 2017 36 Proportion of population using safely managed sanitation service⁵ 6.2.1 2017 – Proportion of population using a handwashing facility with soap and water 6.2.2 2017 – – – 60 Drinking water services and sanitation 2010 2015 5 10 15 20 Pe rce nta ge (% ) 6.5 3.2 5.6 5.4 Prevalence of wasting among children under-5 years of age Rural Urban Rural Urban Total 0 25 50 75 100 PM 2. 5 35.3 35.4 35.3 Concentration of fine particulate mater (PM 2.5), by place of residence Rural Urban Total Number of cases of poliomyelitis caused by wild poliovirus (WPV) No cases have been reported in the past 5 years 20102012 20142016 0 25 50 75 100 Pe rce nta ge (% ) 28.1 28.1 Prevalence of raised blood pressure among persons* 20102012 2014 2016 0 25 50 75 100 Pe rce nta ge (% ) 2.1 3.3 Prevalence of obesity among children and adolescent* (5–19 years) 20102012 2014 2016 0 25 50 75 100 Pe rce nta ge (% ) 4.9 6.4 Prevalence of obesity among adults* (18+ years) Additional SDG indicators used to monitor the GPW13 impact