National capacity for prevention and control of NCDs in SEA Region 2019: Country profiles - Bhutan

Total populationa: 771 612 GDP per capita (in US$)b: 3243.2 Total deaths (2016)c: 4700 Total NCD deaths (NCD deaths as % of total deaths)c: 3200 (68%) BHUTAN National capacity for prevention and control of NCDs in SEA Region 2019: Country profiles Off track1 Premature mortality (probability of dying before the age of 70, %) Tobacco use (%) Heavy episodic drinkers (%) Physical inactivity (%) Obesity (%) Hypertension (%) Per capita salt consumption (g) Population that use solid fuels as primary source for cookingd (%) Incomplete data On track2 Global targetsd (in terms of relative percentage reduction) 25 30 10 10 Halt the rise 25 30 50 (Regional goal only) Country targets (in terms of relative percentage reduction) 25 30 10 10 Halt the rise 25 30 50 Baselinee 25.1 (2010) 24.8 (2014) 22.4 (2014) 6.4 (2014) 6.2 (2014) 35.7 (2014) 9.0 (2014) 36.0 (2010) Current statusf 23.3 (2016) 22.9 (2019) 16.6 (2019) 5.9 (2019) 11.4 (2019) 28.2 (2019) 8.3 (2019) 23.0 (2018) National targets (Absolute) (2025) 18.8 17.4 20.7 5.8 6.2 26.8 (2019) 6.3 (2019) 18.0 I. Public health infrastructure, partnerships and multisectoral collaboration for NCDs and their risk factors An exclusive organizational unit for NCDs Total number of staff Yes 2–5 Multisectoral mechanism (Year of establishment) Operational (2015) Chair of multisectoral mechanism Minister of Health Dedicated funding for NCDs Yes (except palliative care) Earmarking of taxes from tobacco and alcohol for health Tobacco (None) Alcohol (None) II. Plans, policies and strategies Integrated multisectoral action plan addressing all risk factors & diseases Multisectoral National Action plan to prevent and control Noncommunicable Disease (2015-2020) Is the plan costed No Operational tobacco control law/ regulation Penal Code of Bhutan, 11 Aug 2004 Operational alcohol control law/regulation for comprehensive ban Yes (national alcohol policy) Tobacco taxes as percentage of price of 20 most sold brand of cigarettes (2018)g Not applicable, as tobacco products banned Affordability in 2018 of cigarettes – less since 2008g Not Applicable Guidelines for physical activities with recommended level for children, adolescents and adults Yes Implementation of national public awareness campaigns for physical activity No Availability of food-based dietary guidelines Yes Front-of-pack labelling for packaged foods to indicate high level of sugar, salt, saturated fats or transfat No Salt control policy – on reformulation of food No Salt control policy – front-of-pack labelling No Implementation of public campaigns for salt No m-health interventions for NCD risk factors & NCDs No III. Capacity for NCD early detection, treatment and care within the health system Availability of evidence-based guidelines/protocols in primary care settings by public authorities for the management of NCDs (Cardiovascular disease, diabetes cancer, chronic respiratory disease) Yes Alcohol dependence, tobacco dependence, overweight/obesity & physical inactivity Yes (except overweight/obesity) Availability of basic technologies in 50% or more health-care facilities in the public sector Equipment for measurement of height and weight Yes Blood glucose measurement Yes Oral glucose tolerance test No HbA1c test No Dilated fundus examination No Foot vibration perception by tuning fork No Urine strips for glucose and ketone measurement Yes Blood pressure measurement Yes Total cholesterol measurement No Urine strips for albumin assay Yes Peak flow measurement spirometry No Availability of essential medicines for prevention and control of NCDs in primary care facilities Anti-diabetic medication Metformin (Yes), sulphonylureas (No), insulin (No) HPV vaccination Yes Anti-hypertensive drugs Thiazide diuretics (Yes), ACE inhibitors (No), ARBs (Yes), calcium channel blockers (No), beta blockers (Yes) Cardiovascular disease drugs Aspirin 75/100 mg (Yes), statins (No) Chronic respiratory disease drugs Bronchodilator (Yes), Steroid inhaler (No) Oral morphine No Benzathine penicillin injection Yes Nicotine replacement therapy No Screening for cervical cancer (Program, Method, Coverage) Opportunistic, PAP, 50%–70% Proportion of health facilities offering CVD risk stratification 25%–50% IV. Health information systems and surveillance Exclusive dedicated staff/office/department/division Noh A functional system (either CRVS or SRS) that provide national reliable estimates of mortality from main NCDs Yes (CRVS) % of deaths registered in CRVS 50%–74% Time lag in availability of mortality data from CRVS/SRS (latest year of data available) 1 year (2018) Risk factor data among adolescents (with latest year of data available): An integrated risk factor survey within last 5 years Availability of at least two data points for most risk factors in last 10 years Yes (2016) No (2016) Risk factor data among adults (with latest year of data available): An integrated risk factor survey within last 5 years Availability of at least two data points for most risk factors in last 10 years Yes (2019) Yes (2014, 2019) Time lag in publication of data from (with latest year of data available): Most recent integrated risk factor survey Cancer registry Diabetes registry <1 year (2019) 1 year (2018) 1 year (2018) a. United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019, Online Edition. b. World Bank national accounts data (2019). c. WHO Global Health Estimates (2016) as downloaded from GHO (https://apps.who.int/gho/data/node.searo.A860). d. The regional targets set in “Action plan for the prevention and control of noncommunicable diseases in South-East Asia, 2013–2020” are the same as the global targets set in 2013 in “Global NCD monitoring framework” for all indicators except for an additional regional target of “50% relative decrease in households using solid fuels as primary source for cooking between 2010 and 2025”. Though the indicator in the Regional plan and national plan refers to the percentage of “households” using solid fuel, data on the percentage of the “population” using solid fuels is presented here. e,f Sources of data: Premature mortality (Probability of dying before age 70): Both the baseline and current situation data are based on WHO Global Health Estimates (2016) as downloaded from GHO (https://apps.who.int/gho/data/node.searo.A857) Tobacco use (Percentage of population using any tobacco product-smoked or smokeless): Both the baseline and current situation data from the National NCD risk factor surveys in 2014 (https://www.who.int/ncds/surveillance/steps/Bhutan_2014_ STEPS_FactSheet.pdf) and in 2019. The factsheet for 2019 has been released but the full report is yet to be released, the data are based on published factsheet. Heavy episodic drinking (alcohol): Data source as per the tobacco use. Physical inactivity (Percentage with <150 minutes of activity per week): Data source as per the tobacco use. Obesity (BMI≥30 Kg/m2): Data source as per the tobacco use. Hypertension (Percentage with raised blood pressure (SBP≥140 and/or DBP≥90 mmHg) or currently on medication for raised blood pressure): Data source as per the tobacco use. Per capita salt consumption: Data source as per the tobacco use. Percentage of population that use solid fuels as primary source of cooking: the data are from Global Household Energy Database, 2020 update. (https://apps.who.int/ gho/data/node.searo.SDGFUELS712). The percentage of households using solid fuels is estimated as (100 - percentage of population with primary reliance on clean fuels and technologies). g. WHO report on the global tobacco epidemic 2019. https://apps.who.int/iris/bitstream/ha ndle/10665/326043/9789241516204-eng.pdf h. NCD surveillance being shared across several offices/departments or administrative divisions within MoH 1. Off track: Country may have made progress on the indicator, but the rate of progress made is not sufficient to achieve the 2025 target. As of the current year for which data are available, the country is behind by at least two years equivalent to the annual decline needed between 2010 and 2025 to achieve the target. The country needs to accelerate the rate of progress to achieve the 2025 target. 2. On track: The rate country has made sufficient progress between 2010 and the year for which data are available, and are either ahead or less than 2 years offtrack to achieve the goal by 2025. If the country continues to make the progress at the same or slightly higher rate, it will be able to achieve the 2025 target. For full report refer to https://apps.who.int/iris/handle/10665/333806 For technical information, please contact: Dr Manju Rani, Regional Adviser (NCD Governance, Policy, and Surveillance), Email: ranim@who.int; Mr Naveen Agarwal, Surveillance Management Associate, Email: agarwaln@who.int BHUTAN