2018 Health SDG Profile: Bhutan Last updated July, 2018 80% Out-of-pocket expenditure³ 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 40.8% Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Bhutan, from 2000 (60.2 years) to 2016 (70.6 years), the life expectancy at birth has improved by 10.4 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Bhutan, from 2000 (52.9 years) to 2016 (60.7 years), healthy life expectancy has improved by 7.8 years. Population (000s)¹ 817 Poverty³ 2.2% GDP per capita³ (Current US$) 3110.2 Current health expenditure as share of GDP³ 3.5% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 53 6160 71 Life expectancy at birth Healthy life expectancy Monitoring the health SDG goal: Indicators of overall progress (ppp < $1.90 a day) 5.7% The goal of universal health coverage (UHC) is that all people and communities receive the health care they need, without suffering financial hardship. Monitoring UHC requires measuring health service coverage and financial protection (SDG target 3.8). Universal health coverage: At the centre of the health goal HEALTH SERVICE COVERAGE A summary measure of essential health services coverage, a composite service coverage index, is used:16 indicators are derived from four main areas of work: (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: 0.3% or approximately 2 000 people are being pushed into poverty because of out-of-pocket health spending³. Catastrophic expenditure on health: 4.1% of people spent more than 10% of their household's total expenditure on health care³. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DTP3)⁶ 0 50 100 C ov er ag e (% ) 9985 78 74 Reproductive, maternal, newborn and child health Latest available data (2010-2017) HIV antiretroviral therapy coverage⁷ Tuberculosis treatment Coverage⁷ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ 0 50 100 C ov er ag e (% ) 100 36 80 63 Infectious diseases Prevalence of normal blood pressure in population¹⁰ Cervical cancer screening¹¹ Tobacco non-use¹² Prevalence of normal fasting glucose level¹⁰ 0 50 100 C ov er ag e (% ) 72 64 75 88 Noncommunicable diseases Density of hospital beds¹³, expressed as % of global threshold, 18/10 000 Heath worker density¹⁴, expressed as % of new global threshold, 44.5/10 000 Health security: IHR compliance¹⁰ Access to essential medicines 0 50 100 C ov er ag e (% ) 100 44 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 averaging service coverage values across the 16 tracer indicators. The UHC coverage index ranges from 0% to 100%, with 100% implying full coverage across a range of services. UHC services coverage index 0 50 100 C ov er ag e (% ) 72 UHC services coverage index Out-of-pocket expenditure, as % of the health expenditure (2015) Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. This profile provides an overview of the current status of achieving better health towards the 13 targets under the Sustainable Development Goal #3 (SDG3): Ensure healthy lives and promote well-being for all at all ages. All 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 5.7%20% ( p < a day) 9.1% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year 2018 Health SDG Profile: Bhutan No data Variation by income Equity : Leave no one behind SDGs emphasis on equity SDG target 17.18 emphasizes the need for disaggregated data. By 2020, enhance capacity-building support to developing countries to increase significantly the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, location and other characteristics relevant in national contexts. Variation by geography SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Births attended by skilled health personnel⁵ 2000 2005 2010 2012 2016 0 50 100 C ov er ag e (% ) 24 49 65 75 58 Maternal mortality ratio¹⁷ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 423 148 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 33 18 80 32 Child mortality¹⁸ Children under-five Neonatal SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Variation by education 2000 2005 2010 2015 0 50 100 M or ta lit y ra te Under 5 mortality⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (Modern) prevalence rate⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 82.7 Birth Registration¹⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 81.0 Death Registration¹⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 50.0 Cause of death¹⁶ No data 2000 2005 2010 2015 0 Pe rc en ta ge Full Immunization⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ Strengthening Civil Registration and Vital Statistics (CRVS) Rural Urban 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation¹⁰ Quintile 1 (poorest) Quintile 5 (richest) No data No education Secondary school + Primary school 2018 Health SDG Profile: Bhutan Current data are insufficient to determine trend 0.0 0.2 0.4 HI V IR [1 00 0 un in fe ct ed p op .] Malaria incidence⁹ 2012 2013 2014 2015 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] 2.8 0.27 TB incidence⁷ 2011 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] 211 178 Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s Communicable diseases (SDG target 3.3) Indicators SDGtarget Year Bhutan Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 23.3 23.1 Noncommunicable diseases and injuries Tobacco use among persons (18-69 yrs) and older - Female 3.a.1 2014 13.6 Tobacco use among persons (18-69 yrs) and older - Male 3.a.1 2014 33.6 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 2.57 - - Essential medicines and vaccines International Health Regulations Core Capacity Index¹⁰ 3.d.1 2017 73 73 National and global health risks Note: A dash (-) implies relevant data are not available Health worker density¹⁴ (per 10 000 population) 3.c.1 2017 19.3 - Health workforce 0.6 0.0 Malaria incidence is calculated for confirmed malaria cases Indicators Year Bhutan Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 0.81 Number of people requiring interventions against neglected tropical diseases⁴ 2016 241,761 0.70 671,797,672 Suicide rate⁴ (per 100,000 population) 3.4.2 2016 11.4 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 0.6 Mortality rate from road traffic injuries⁴(per 100,000 population) 3.6.1 2016 15.1 13.2 4.5 17.0 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op .) Total NCD mortality¹⁰ Female Male 2010 2012 2016 0 50 100 150 Ad ol es ce nt b irt h ra te [w om en t a ge d 15 -1 9 yr s] 28 59 Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁹ Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods(%)⁵ 3.7.1 2016 84.6 Adolescent birth rate¹⁹ (per 1000 women aged 15 to19 years) 3.7.2 2014 28.4 75.1 33 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 124.5 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 4.0 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.6 164.0 15.4 1.8 Mortality due to environmental pollution 2018 Health SDG Profile: Bhutan Prevalence of children under 5 years who are overweight⁵ 1999 2008 2010 0 8 15 Pr op or tio n (% ) Prevalence of children under 5 years of age who are wasted⁵ 2008 2010 0 50 100 Pr op or tio n (% ) Prevalence of children under 5 years of age who are stunted⁵ 2008 2010 0 50 100 Pr op or tio n 33.634.9Children under 5 years who are stunted⁴ 2.2.1 2010 33.6 Children under 5 years who are wasted⁴ 2.2.2 2010 5.9 Children under 5 years who are overweight⁴ 2.2.3 2010 7.6 33.0 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources⁴ 6.1 2015 34 Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 52 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 35.4 57.3 Ambient air pollution Number of deaths by disaster⁴ ( per 100 000 people) 13.1.2 2016 0.00 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 1.7 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2016 0 4.1 0.1 Homicide and conflicts Birth registration coverage¹⁵ 16.9.1 2015 100 - Birth registration Note: A dash (-) implies relevant data are not available Completeness of cause-of-death data¹⁶ (%) 17.19.2 2016 - 10 Cause-of-death data Indicators SDGtarget Year Bhutan Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 9.1 8.5 General government health expenditure 4.7 5.9 3.9 7.6 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 10 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 10 July 2018). 3. Global health expenditure database. Geneva: World Health Organization; June 2016 (http://apps.who.int/nha/database, accessed 10 July 2018). 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization；2018 （http://www.who.int/gho/mortality_burden_disease/life_tables/en/ , accessed 10 July 2018）. 5. Bhutan national health survey 2012. Thimphu: Ministry of Health, Royal Government of Bhutan; 2012 (http://www.health.gov.bt/publications/national-health-survey/, 10 July 2018). 6. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization (http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 11 July 2018). 7. Global tuberculosis report 2017.Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516, accessed 11 July 2018). 8. UNAIDS 2016 estimates for coverage of people receiving ART. UNAIDS (http://aidsinfo.unaids.org, accessed 11 July 2018). 9. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 21 July 2018). 10. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 21 July 2018). 11. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan, 2014. New Delhi: World Health Organization, Regional Office for South-East Asia; 2015 (http://www.who.int/ncds/surveillance/steps/Bhutan_2014_STEPS_Report.pdf, accessed 11 July 2018). 12. CVD vs Tobacco factsheet http://www.searo.who.int/entity/ncd_tobacco_surveillance/documents/bhu_wntd_18/en/ - accessed 20 June 2018 13. World health statistics 2013. Geneva: World Health Organization; 2013. 14. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 17. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 18. Levels & trends in child mortality: report 2015: 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; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 19. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018
2018 Health SDG Profile: Bhutan Last updated October, 2018 80% Out-of-pocket expenditure²¹ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection. Bhutan Urban population¹ 37.8% Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Bhutan, from 2000 (60.2 years) to 2016 (70.6 years), the life expectancy at birth has improved by 10.4 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Bhutan, from 2000 (52.9 years) to 2016 (60.7 years), healthy life expectancy has improved by 7.8 years. Population (000s)¹ 736 Poverty² 2.2% GDP per capita² (Current US$) 3110.2 Current health expenditure as share of GDP³ 3.9% 2000 2007 2015 2016 0 50 100 A ge (y ea rs ) 53 6160 71 Life expectancy at birth Healthy life expectancy Monitoring the health SDG goal: Indicators of overall progress (ppp < $1.90 a day) 5.7% The goal of universal health coverage (UHC) is that all people and communities receive the health care they need, without suffering financial hardship. Monitoring UHC requires measuring health service coverage and financial protection (SDG target 3.8). Universal health coverage: At the centre of the health goal HEALTH SERVICE COVERAGE A summary measure of essential health services coverage, a composite service coverage index, is used:16 indicators are derived from four main areas of work: (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: 0.3% or approximately 2 000 people are being pushed into poverty because of out-of-pocket health spending²¹. Catastrophic expenditure on health: 4.1% of people spent more than 10% of their household's total expenditure on health care²¹. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DTP3)⁶ 0 50 100 C ov er ag e (% ) 9985 78 74 Reproductive, maternal, newborn and child health Latest available data (2010-2017) HIV antiretroviral therapy coverage⁷ Tuberculosis treatment Coverage⁷ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ 0 50 100 C ov er ag e (% ) 100 36 80 63 Infectious diseases Prevalence of normal blood pressure in population¹⁰ Cervical cancer screening¹¹ Tobacco non-use¹² Prevalence of normal fasting glucose level¹⁰ 0 50 100 C ov er ag e (% ) 72 64 75 88 Noncommunicable diseases Density of hospital beds¹³, expressed as % of global threshold, 18/10 000 Heath worker density¹⁴, expressed as % of new global threshold, 44.5/10 000 Health security: IHR compliance¹⁰ Access to essential medicines 0 50 100 C ov er ag e (% ) 100 44 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 averaging service coverage values across the 16 tracer indicators. The UHC coverage index ranges from 0% to 100%, with 100% implying full coverage across a range of services. UHC services coverage index 0 50 100 C ov er ag e (% ) 72 UHC services coverage index Out-of-pocket expenditure, as % of the health expenditure (2015) Public spending on health²¹ is determined by the capacity of the government to raise revenues and allocate it to health. This profile provides an overview of the current status of achieving better health towards the 13 targets under the Sustainable Development Goal #3 (SDG3): Ensure healthy lives and promote well-being for all at all ages. All 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 5.7%20% ( p < a day) 9.1% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year 2018 Health SDG Profile: Bhutan No data Variation by income Equity : Leave no one behind SDGs emphasis on equity SDG target 17.18 emphasizes the need for disaggregated data. By 2020, enhance capacity-building support to developing countries to increase significantly the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, location and other characteristics relevant in national contexts. Variation by geography SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Births attended by skilled health personnel⁵ 2000 2005 2010 2012 2017 0 50 100 C ov er ag e (% ) 24 49 65 75 97 Maternal mortality ratio¹ &¹⁷ 20 00 20 05 20 10 20 15 20 17 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 423 89 2000 2005 2010 2015 2016 2017 0 50 100 150 M R [1 00 0 liv e bi rth s] 33 18 80 34 Child mortality¹⁸ Children under-five Neonatal SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Variation by education 2000 2005 2010 2015 0 50 100 M or ta lit y ra te Under 5 mortality⁵ 2000 2005 2010 2015 0 50 100 P er ce nt ag e Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 P er ce nt ag e Contraceptive (Modern) prevalence rate⁵ 2000 2005 2010 2015 0 50 100 P er ce nt ag e 82.7 Birth Registration¹⁵ 2000 2005 2010 2015 0 50 100 P er ce nt ag e 81.0 Death Registration¹⁵ 2000 2005 2010 2015 0 50 100 P er ce nt ag e 50.0 Cause of death¹⁶ No data 2000 2005 2010 2015 0 P er ce nt ag e Full Immunization⁵ 2000 2005 2010 2015 0 50 100 P er ce nt ag e Stunting⁵ Strengthening Civil Registration and Vital Statistics (CRVS) Rural Urban 2000 2005 2010 2015 0 50 100 P er ce nt ag e Sanitation¹⁰ Quintile 1 (poorest) Quintile 5 (richest) No data No education Secondary school + Primary school 2018 Health SDG Profile: Bhutan Current data are insufficient to determine trend 0.0 0.2 0.4 HIV IR [1 00 0 u nin fec ted po p.] Malaria incidence⁹ 2012 2014 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s Communicable diseases (SDG target 3.3) Indicators SDGtarget Year Bhutan Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 23.3 23.1 Noncommunicable diseases and injuries Tobacco use among persons (18-69 yrs) and older - Female 3.a.1 2014 13.6 Tobacco use among persons (18-69 yrs) and older - Male 3.a.1 2014 33.6 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 2.57 - - Essential medicines and vaccines International Health Regulations Core Capacity Index¹⁰ 3.d.1 2017 73 73 National and global health risks Note: A dash (-) implies relevant data are not available Health worker density¹⁴ (per 10 000 population) 3.c.1 2017 19.3 - Health workforce 0.6 0.0 Malaria incidence is calculated for confirmed malaria cases Indicators Year Bhutan Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 0.81 Number of people requiring interventions against neglected tropical diseases⁴ 2016 241,761 0.70 671,797,672 Suicide rate⁴ (per 100,000 population) 3.4.2 2016 11.4 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 0.6 Mortality rate from road traffic injuries⁴(per 100,000 population) 3.6.1 2016 15.1 13.2 4.5 17.0 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op .) Total NCD mortality¹⁰ Female Male 2010 2012 2016 0 50 100 150 A do le sc en t b irt h ra te [w om en t a ge d 15 -1 9 yr s] 28 59 Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁹ Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods(%)⁵ 3.7.1 2016 84.6 Adolescent birth rate¹⁹ (per 1000 women aged 15 to19 years) 3.7.2 2014 28.4 75.1 33 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 124.5 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 4.0 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.6 164.0 15.4 1.8 Mortality due to environmental pollution 2012 2014 2016 0 100 200 TB In ci de nc e ra te / 10 00 0. . TB incidence rate¹ &⁷ 2018 Health SDG Profile: Bhutan Prevalence of children under 5 years who are overweight⁵ 1999 2008 2010 0 8 15 P ro po rti on (% ) Prevalence of children under 5 years of age who are wasted⁵ 2008 2010 0 50 100 P ro po rti on (% ) Prevalence of children under 5 years of age who are stunted⁵ 2008 2010 0 50 100 P ro po rti on 33.634.9Children under 5 years who are stunted⁴ 2.2.1 2010 33.6 Children under 5 years who are wasted⁴ 2.2.2 2010 5.9 Children under 5 years who are overweight⁴ 2.2.3 2010 7.6 33.0 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources²⁰ 6.1 2015 98 Proportion of population using improved sanitation²⁰ 6.2 2015 74 - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 52 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 35.4 57.3 Ambient air pollution Number of deaths by disaster⁴ ( per 100 000 people) 13.1.2 2016 0.00 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 1.7 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2016 0 4.1 0.1 Homicide and conflicts Birth registration coverage¹⁵ 16.9.1 2015 100 - Birth registration Note: A dash (-) implies relevant data are not available Completeness of cause-of-death data¹⁶ (%) 17.19.2 2016 - 10 Cause-of-death data Indicators SDGtarget Year Bhuta.. Regional estimate General government health expenditure as % of general government expenditure³ 1.a 2017 12 8.5 General government health expenditure 4.7 5.9 3.9 7.6 References 1. 2017 Population and Housing Census of Bhutan ( www.nsb.gov.bt/publication/files/PHCB2017_national.pdf ) 2. World development indicators (http://databank.worldbank.org/) 3. National Health Accounts Study 2014-15 & 2015-16 ( http://www.health.gov.bt/wp-content/uploads/afd-files/2015/11/NHA-2014-15-and-2015-16-final-2018.pdf ) 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization；2018 （http://www.who.int/gho/mortality_burden_disease/life_tables/en/ , accessed 10 July 2018）. 5. Bhutan national health survey 2012. Thimphu: Ministry of Health, Royal Government of Bhutan; 2012 (http://www.health.gov.bt/publications/national-health-survey/, 10 July 2018). 6. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization (http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 11 July 2018). 7. Global tuberculosis report 2017.Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516, accessed 11 July 2018). 8. UNAIDS 2016 estimates for coverage of people receiving ART. UNAIDS (http://aidsinfo.unaids.org, accessed 11 July 2018). 9. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 21 July 2018). 10. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 21 July 2018). 11. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan, 2014. New Delhi: World Health Organization, Regional Office for South-East Asia; 2015 (http://www.who.int/ncds/surveillance/steps/Bhutan_2014_STEPS_Report.pdf, accessed 11 July 2018). 12. CVD vs Tobacco factsheet http://www.searo.who.int/entity/ncd_tobacco_surveillance/documents/bhu_wntd_18/en/ - accessed 20 June 2018 13. World health statistics 2013. Geneva: World Health Organization; 2013. 14. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 17. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 18. Levels & trends in child mortality: report 2015: 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; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 19. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018. 20. Annual health Bulletin, Ministry of Health, Bhutan, 2018 ( http://www.health.gov.bt/wp-content/uploads/ftps/annual-health-bulletins/Annual%20Health %20Bulletin-2018 ) 21. World Health Organization. Global health expenditure database ( http://apps.who.int/nha/database/Select/Indicators/en)