Launch of Bhutan Bachelor of Public Health Programme.

Speech by Dr Samlee Plianbangchang Regional Director, WHO South-East Asia At the Launch of Bhutan BPH Programme 13 April 2010 Thimphu, Bhutan 1 Launch of Bhutan Bachelor of Public Health Programme 13 April 2010 Thimphu, Bhutan Speech by Dr Samlee Plianbangchang WHO Regional Director, South-East Asia ------------- Excellency Lyonpo Zangley Dukpa, Minister of Health, the Royal Government of Bhutan (RGB), Excellency, Lyonpo Wangdi, Honorable Minister of Labour and Human Resources, RGB, Excellencies, Dr Phitaya Charupoonphol, Dr Hasbullah Thabrany, Dr Gado Tshering, Dr Jigmi Singay, Dr Orapin Singhadej, representatives from international agencies, honourable guests, ladies and gentlemen, It is my priviledge to join the launch of the Bachelor’s Degree Programme in Public Health (BPH) in Thimphu, Bhutan. I overwhelmingly thank the Royal Government of Bhutan for the invitation. Even though the Government is to host the SAARC Summit in a few days’ time, it still decided to launch this programme on schedule as planned. This decision reflects the high priority that the Royal Government of Bhutan accords to health development, and the development of the “public health workforce” for the country in particular. Ladies and gentlemen, In the health area, Bhutan has been extraordinarily successful over the last few decades. The country’s crude death rate had declined from 9 per 1000 population in 1994 2 to 7 in 2005. Life expectancy at birth increased from 47.5 years in 1984 to 66.1 in 2005. Infant mortality rate decreased from 70.7 per 1000 live births in 1994 to 40 in 2005. Maternal mortality ratio had been lowered from 380 per 100000 live births in 1994 to 255 in 2000. The current coverage of PHC is more than 90% of all health services. These are some of the important health indicators of the country. These are the reflections in some of the important health indicators of the country. With the launch of the national initiative on “Gross National Happiness”, the health status of the Bhutanese people has been further elevated. The philosophy of Gross National Happiness was propounded by His Majesty the King Jigme Singye Wangchuk in the late 1980s. As far as health infrastructure in Bhutan is concerned, among others, the Basic Health Units were developed to be the cornerstone of community health services throughout the country. Primary health care has been firmly established in rural community country-wide; and referral systems have been well defined and strengthened from the primary to secondary and tertiary levels of care. In general, Bhutanese people look healthier and happier today; than they did at least 30 years ago. In recognition of the achievements in health development in Bhutan: • The Mongar Health Service Development Project won the WHO Sasakawa Health Prize and Award in 1993; • Many districts in the country have been awarded by the WHO Tobacco Free Initiative on a number of occasions; 3 • The Royal Institute of Health Sciences received the WHO Award for PHC Development in 1998. These are among the notable recognitions received by the Royal Government of Bhutan for its health development efforts. Certainly, ladies and gentlemen, these achievements are due to selfless dedication and hard work of all Bhutanese health staff and other players at all levels; these achievements have been built on the concrete foundation of a well conceived development strategy, which has been followed since the beginning of national development endeavours. This strategy reflects national determination to work towards long-term sustainable development and national self- reliance; the main pillar to realize this development strategy is the human resource development (HRD) to ensure efficient and effective implementation of national development plan. Excellencies; In spite of the past success, today, Bhutan continues facing many challenges in health area; such as; • Ensuring the achievement of universal coverage through reaching the unreached in the remote areas; • Ensuring the attainment of heath and health-related MDGs in the year 2015; • Mitigating the prevailing health impact of “climate change”; and • Combating emerging infectious diseases, such as influenza H1N1, among others. 4 To tackle these challenges successfully, “institutional health care” must be firstly well developed. This is the care that is provided primarily at health facilities – hospitals and health centres. In addition to institutional care; priority attention is urgently needed for further strengthening and further developing “community and population-based” health services that can be extended beyond the “walls” of health facilities, the walls of hospitals or health centers. The services that can be made available right at families and workplaces in community, in villages. To do this effectively, we may need to start firstly, with a “revisit” of the “community- based health workforce”. Community-based health workers, who are important part of public health workforce, are the vanguards of national health services delivery systems, especially in rural areas. Bhutan has been successful in the development of community- based health workforce. A basic cadre of rural community-based health staff has been set up to man the BHUs, and their satellite out-reach units in the remote areas. These health staff are: • Health Assistant (HA), • Auxilliary Nurse Midwife (ANM), and • Basic Health Workers (BHW). For decades, hundreds of these health staff have been trained and are in service with the Government. These staff members have greatly contributed to the successful development and implementation of community-based health services in the country. They have been the mainstay of PHC development. They provide primary care and services to 5 rural people. And they play critical role in education and empowerment of rural population, as far as health is concerned. They have contributed significantly to the upliftment of the health of the people, especially in rural areas. In this connection, I must also mention that such effective contribution from community from community health staff cannot go alone. Effective community health services must be supported by functional referral systems for higher levels of care. And community health staff must be provided with effective institutional support for their education, training and supervision. In Bhutan, Excellencies, many of Health Assistants have moved up to be District Health Officers; and to be other categories of health staff at the district level. Some of them have also taken up service at the headquarters of the Ministry of Health in Thimphu, in various capacities. Ladies and gentlemen; It is now an opportune time to further strengthen the education and career opportunities of these community health staff so that they will be encouraged to perform their functions with more enthusiasm and commitment. Raising the level of education of community-based health workforce will be an important step in strengthening community- based health services. They will be more energetic in improving their competence and skills; and they will be willing to dedicate more energy and efforts to serve the rural people. Their pride and morale as members of the community-based health workforce will also be reinforced. 6 Therefore, the decision to launch the Bachelor’s Degree Programme in Public Health in Bhutan is indeed very highly commendable. It is a very timely decision as far as health development in Bhutan is concerned. The status of the community-based health workforce will be raised to a “professional level”. Certainly, this educational programme will further strengthen the overall health system capability in the country, particularly at the district level and below. At the community level, health systems will be able to deliver a “better quality” health care and services. Among others, the community will be better prepared to deal with local health challenges. This is especially true in responding appropriately to disease outbreaks and events of disasters. Planning, implementation, monitoring and supervision of community health services will be improved. As we are aware, Bhutan is also prone to several natural disasters. This public health education programme should also be carefully designed to contribute effectively to the country capacity building in disaster preparedness and response. The programme should be involved in training of community health workforce, including community health volunteers who have a critical role to play in promoting the building of community capacity and resilience in emergency. I am pleased to note that the Royal Government of Bhutan is according top priority to this important area. And I am sure that the subject of “disaster management”, will be prominently incorporated as a part of the course content of this BPH programme. In running this public health education programme, I would like to underline the crucial importance of “faculty development”. We need a faculty development “plan” that is 7 realistic, practical and flexible in its implementation. A plan that leads to the development of a core faculty staff, who can effectively manage and coordinate the course contents, and activities of teaching-learning process of the programme. It is necessary that “local expertise” needs to be “maximally mobilized” for the running of the course. I also earnestly encourage other “international agencies/organizations” operating in the country to participate fully in this important exercise. As far as collaboration with institutions in other countries is concerned; working through South-East Asia Public Health Education Institutions Network (SEAPHEIN) will take Bhutan a long way forward in collaborating with other institutions in the Region. WHO has been playing a supporting role in the development of this public health education programme. And WHO and other partners are more than willing to continue this supporting role in future. I would like to take this opportunity to thank Faculty of Public Health, Mahidol University (FPH/MU) and other members of SEAPHEIN for their encouragement and support extended to the development of this educational programme. Ladies and gentlemen, I would like to express my sincere appreciation to all dignitaries and honourable guests, for their presence at this launch ceremony. I deeply appreciate the contribution of various committees, groups and technical advisers who have been involved in bringing the BPH programme to this stage of development. And again, I would like to sincerely congratulate the Royal Government of Bhutan for this important development in health. Let us also hope that this educational programme 8 would significantly contribute to the strengthening of the required leaderships and stewardships of Bhutan health sector. The programme has already started. Let us hope that it would stay, continue, grow and grow further; in order to ensure meeting the requirements for public health workforce of the country. Thank you.