BhutanUrban population

(1)

2019 Health SDG Proﬁ le: Bhutan

80%

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

41.6%

Life expectancy at birth

Life expectancy⁵ measures how long people will live and is an indication of overall mortality of a country's population. Lost healthy life expectancy (HALE) represents equivalent year(s) of full health lost through years lived with morbidity and disability.

Although females live longer, lost HALE is longer as well, on average 0.7 years or 7.3% more than males.

Population (000s)¹

763

Poverty³

1.5%

GDP per capita³ (Current US$)

3360.3

Current health expenditure as share of GDP

⁴ 3.5%

0 20 40 60 80

Age (years) Male

Female

HALE Lost HALE

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 SERVICES COVERAGE

The summary measure of essential health services coverage, service coverage index of 16 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 4 600 people are being pushed into poverty (at $1.90 level) because of out-of-pocket health spending¹⁷ .

Catastrophic expenditure on health: 1.8% of people spent more than 10% of their household's total expenditure on health care¹⁸.

Family planning

coverage⁶ Pregnancy and

delivery care⁶ Child immunization

coverage⁷ (DTP3) Care seeking behaviour suspected pneumonia⁶ 0

50 100

Coverage (%) ₉₈

85 86 74

Reproductive, maternal, newborn and child health

Latest available data (2010-2019)

Tuberculosis (effective) treatment

Coverage⁸

HIV antiretroviral

therapy coverage⁹ Insecticide-treated bednets/IRS coverage for malaria prevention¹⁰

Access to at least basic sanitation¹¹

(%) 0

50 100

Coverage (%) ₁₀₀

76

33

63

Infectious diseases

Prevalence of normal fasting glucose level¹²

Prevalence of normal blood pressure¹²

Cervical cancer

screening¹³ Tobacco non-use¹³ 0

50 100

Coverage (%)

100

72 64 75

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

Access to essential

medicines¹⁵ Health security: IHR compliance¹⁶ 0

50 100

Coverage (%)

97

44

95

53

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.

2010 2019

0 50 100

Coverage (%)

65 73

UHC services coverage index

Out-of-pocket expenditure, as % of the health expenditure (2016)

Public spending on health ⁴ is determined by the capacity of the government to raise revenues and the level of priority it attaches to the health sector.

This profile provides an overview of the current status of progress towards the 13 targets under the

Sustainable Development Goal #3 (SDG3): Ensure healthy lives and promote well-being for all at all ages.

All SDG3 indicators plus other selected health-related indicators are presented using global health estimates or country comparable reported values if available.

When nationally reported indicators from other sources are available, these are included in the references.

20.1%

70.4

70.8

(2)

2019 Health SDG Proﬁ le: Bhutan

Equity status and trends: Variation by income, geographical location and education*

*There are many dimensions of equity, including but not limited to examples based on income, geographical location, and education presented here but also age, sex, race, and others. SDG 17.18 emphasizes the need for disaggregated data to facilitate better measurement of inequalities.

SDG 3: Health targets

Maternal and child mortality (SDG target 3.1, 3.2)

Births attended by skilled health personnel⁶

⋅

¹⁹

2000 2005 2010 2012

0 50 100

Pe rc en ta ge (% )

23.7

49.1

64.5

74.6

Maternal mortality ratio²⁴

2000 2005 2010 2015

0 150 300 450

M M R (p er 1 00 0 00 li ve b irt hs )

_423.0

148.0

2000 2005 2010 2015 2017 0

20 40 60 80

C M R (p er 1 00 0 liv e bi rth s)

32.7

17.0 79.6

31.0

Child mortality²⁵

Children under-five Neonatal

Health service delivery

NCD risk factors

2005 2010 2015

0 50 100

Su cc es s ra te

82.0

95.0

TB treatment success rate for new cases²²

2005 2010 2015

0 50 100

Pe rc en ta ge (% )

^98.0^95.0

Coverage of DTP3 immunization⁷

Cervical cancer screening¹³

64.1%

Women aged 30-49 years ever had a cervical cancer screening test (%)

Female Male

2000 2005 2010 2015

0 25 50

Pe rc en ta ge (% )

1.5 4.7

3.6 8.5

Prevalence of obesity among adults²² (18+ years of age)

2010 2015

0 50 100

Pe rc en ta ge (% )

^87.4^87.1

73.3 82.8

Antenatal care covergae ⁶ ⋅ ¹⁹ ⋅ ²⁰

(4+ visits)

Rural Urban

Variation by education

2011 2013 2015 2017

0 1 2

Pe r p er so n pe r y ea r

1.9 1.7

OPD utilization²¹ (per person per year)

2010 2015

0 50 100

Pe rc en ta ge (% )

22.730.5

20.8

37.4 28.2

10.5

Prevalence of stunting among children under-five

by mother's education level ⁶ ⋅ ²⁰

None Primary Secondary+

2010 2015

0 50 100

Pe rc en ta ge (% )

34.2 95.1

Proportion of births attended by skilled birth attendant⁶

Quintile 1 (poorest) Quintile 5 (richest)

Variation by geographical location

2010 2015

0 50 100

Pe rc en ta ge (% )

61.6

Children < 5 yrs with diarrhoea receiving ORT and continued feeding⁶

Bed occupancy rate²³ (BOR)

Variation by income

2000 2005 2010 2015

0 25 50

Pe rc en ta ge (% )

23.4 24.7

20.1 21.6

Prevalence of raised blood pressure among adults²² (18+ years of age)

Female Male

2010 2015

0 25 50

Pe rc en ta ge (% )

13.6 33.6

Prevalence of tobbaco use¹³

Female Male

60

Bed occupancy rate, 2016

(3)

Malaria incidence¹⁰

⋅

²⁷

2013 2014 2015 2016 2017 0

2 4 6

Incidence (per 1000 pop. at risk)

0.2 0.4 3.5

2.8 2.8

TB incidence²²

2013 2014 2015 2016 2017 0

50 100 150 200 250

TB incidence (per 100,000 pop.)

179 174 155

178 134

Communicable diseases (SDG target 3.3)

Indicators SDG

target Year Bhutan Regional estimate Probability of dying from any of CVD,cancer,

diabetes,CRD between age 30 and age 70²⁸ 3.4.1 2016 23.3 23.1 Noncommunicable diseases and injuries

Malaria incidence is calculated for confirmed cases

Indicators Year Bhutan Regional estimate Hepatitis B surface

antigen prevalance among children under 5 years²⁸ ⋅ ²⁹ (%)

2015 0.81

Number of people requiring interventions against neglected tropical²⁸

2017 234,506

0.26 733,000,000

Suicide mortality rate²⁸

(per 100 000 population) 3.4.2 2016 11.4

Total alcohol per capita (age 15+ years)

consumption²⁸ 3.5.2 2016 0.6

Road traffic mortality rate²⁸

(per 100 000 population) 3.6.1 2016 17.4

13.2 4.5 20.7

2010 2012

0 20 40 60 80 100

Ad ol es ce nt b irt h ra te

28.4 59.0

Adolescent birth rate (per 1000 women aged 15 to 19 years)⁶

⋅¹⁹

Proportion of married or in-union women of reproductive age who have their need for family

planning satisfied with modern⁶ (%) 3.7.1 2010 84.6 71.4 Sexual and reproductive health

New HIV infections²⁶

International Health Regulations Core

Capacity Index¹⁶ 3.d.1 2018 53 56

National and global health risks

Female Male

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 .)

523.2

611.1 616.9

834.3

Total NCD mortality²²

2008 2010 2012 2014 2016 0

5 10 15 20

D ea th s pe r 1 00 0 00 p op ul at io n

^16.3

6.1

Reported road traffic deaths³⁰ (per 100 000 population)

DTP3 immunization coverage among 1-year-

olds⁷ 3.b.1 2017 98

MCV2 immunization coverage by the nationally

recommended age²⁸ 3.b.1 2017 99

PCV3 immunization coverage among 1-year-

olds²⁸ 3.b.1 2017 -

88 77 12 Essential medicines and vaccines

Adolescent birth rate¹⁹ (per 1000 women aged

15 to19 years) 3.7.2 2012 28.4 33

Age-standardized mortality rate attributed to household and ambient air pollution²⁸

(per 100 000 population) 3.9.1 2016 124.5 165.8

Mortality due to environmental pollution

Prevalence of tobacco use among 18-69 years

old¹³- Female 3.a.1 2014 13.6

Prevalence of tobacco use among 18-69 years

old¹³- Male 3.a.1 2014 33.6

- - Tobacco use

Note: A dash (-) implies relevant data are not available Current data are insufficient to determine

trend

Proportion of health facilities that have a core set of relevant essential medicines available

and affordable on a sustainable basis 3.b.3 2016 95 Total net official development assistance to

medical research and basic health per capita²⁸

(US $) 3.b.2 2017 3.19

-

0.6 Health worker density¹⁴

(per 10 000 population) 3.c.1 2016 19.3 -

Health workforce

Mortality rate attributed to exposure to unsafe

WASH services²⁸ (per 100 000 population) 3.9.2 2016 3.9 Mortality rate from unintentional poisoning²⁸

(per 100 000 population) 3.9.3 2016 0.6

15.4

1.8

(4)

References

1. World population prospects: the 2019 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2019 (https://population.un.org/wpp/, accessed 29 June 2019).

2. World urbanization prospects: 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://population.un.org/wpp/, accessed 29 June 2019).

3. World Bank. (https://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 (https://www.who.int/gho/mortality_burden_disease/life_tables/en/, accessed 29 June 2019).

6. Bhutan Multiple Indicator Survey 2010. Thimphu: Ministry of Health, Royal Government of Bhutan; 2012 (http://www.health.gov.bt/publications/national-health-survey/, accessed 28 May 2018).

7. WHO/UNICEF estimates of national immunization coverage. (http://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 (https://www.who.int/tb/publications/global_report/en/, accessed 15 March 2019).

9. HIV Unit, WHO/SEARO

10. Calculated. World Malaria Report 2018. Geneva: World Health Organization; 2018 (https://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. 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).

14.HRH profiles 2018

15. Annual Performance agreement report. Ministry of Health 2017-2018

16. International Health Regulations (2005) Monitoring Framework, GHO data. Geneva: World Health Organization (https://www.who.int/gho/ihr/en/, accessed 21 March 2019).

17. SEARO staff estimates from (Bhutan) Household Income and Expenditure Survey 2016 18. SEARO staff estimates from Bhutan Living Standard Survey 2017

19. Bhutan National Health Survey 2012. Thimphu: Ministry of Health, Royal Government of Bhutan; 2012.

20. Bhutan National Nutrition Survey 2015. Thimphu: Ministry of Health, Royal Government of Bhutan; 2015.

21. Calculated. Bhutan Annual Health Statistics

22. WHO Global Health Observatory (GHO) (https://www.who.int/gho/en/ - accessed 29 June 2019)

23. The Kingdom of Bhutan Health System Review. Health System in Transition. New Delhi: World Health Organization; 2017 (http://apps.searo.who.int/PDS_DOCS/B5319.pdf, accessed March 28 2019) 24. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva; 2015

(http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 28 May 2019). See for Maternal Mortality Ratio. Country reported value: 2017=89; Data source: Population and Housing Census of Bhutan 2017

25. 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 (http://www.childinfo.org/, accessed 28 May 2019). See for under-five mortality. Country reported value: 2017=34; Data source: Population and Housing Census of Bhutan 2017

26. See for New HIV infections among adults 15-49 years. Country reported value: 2014=0.08, 2015=0.06, 2016=0.07, 2017=0.07, 2018=0.07; Data source. National HIV program 27. See for Malaria Incidence rate. Country reported value: 2014=0.07, 2015=0.14, 2016=0.10; 2017=0.08, 2018=0.07; Data Source: National Malaria Program

28. World Health Statistics 2019.

(https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf?ua=1, accessed 28 May 2019)

29. See for Hepatitis B surface antigen (HBsAg) prevalence among children under 5 year. Country reported value: 2017=0.5; Data Source.Serosurvey to estimate the prevalence of biomarkers of infections with Hepatitis B and C viruses and antribodies to measles and rubella. National HIV/AIDS and STI control programme

30. Country reported

31. Vital Statistics Report, Department of Census and Civil Registration. Ministry of Home and Cultural Affair

Other health-related SDGs

Proportion of population with primary reliance on

clean fuel²⁸ (%) 7.1 2016 52 41

Clean household energy

Annual mean concentrations of fine particulate

matter (PM2.5) in urban areas²⁸ (µg/m3) 11.6 2016 35.3 57.3 Ambient air pollution

Mortality rate due to homicide²⁸ (per 100 000

population) 16.1.1 2016 1.7 4.1

Homicide and conflicts

Birth registration coverage³¹ 16.9.1 2017 99.9 -

Birth registration

Note: A dash (-) implies relevant data are not available

Completeness of cause-of-death data (%) 17.19.2 2017 - 10 Cause-of-death data

Indicators SDG

target Year Bhutan Regional estimate Domestic general government health expenditure

as percentage of general government

expenditure⁴ 1.a 2016 8.3 6.7

General government health expenditure

2000 2005 2010 2015 2016 2017 0

50 100

Percentage (%)

32.0

40.0 46.0 52.0 52.0

79.0

Population with primary reliance on clean

fuels²² (%)

2010 2015 2017

0 50 100

Percentage (%)

100.0 100.0

99.9

Birth registration coverage⁶

⋅³¹ (%)

Proportion of ever-partnered women and girls aged 15 yrs and older subjected to physical, sexual or psychological violence by a current or former intimate partner in previous 12 months

5.2 - - -

Intimate Partner Violence

Proportion of population using safely managed

drinking-water services²⁸ 6.1 2015 34

Proportion of population using safely managed

sanitation service 6.2 2015 -

- - Drinking water services and sanitation

Children under 5 years who are stunted²⁰ 2.2.1 2015 21.2 Children under 5 years who are wasted²⁰ 2.2.2 2015 4.3 Children under 5 years who are overweight²⁰ 2.2.3 2015 2.6

31.9 15.1 3.8 Child nutrition

Prevalence of stunting among children under-five⁶

⋅

²⁰ (%)

2008 2010 2015

0 50 100

Percentage (%)

34.9 33.5

21.2

Amount of water- and sanitation-related official development assistance that is part of a government-coordinated spending plan²⁸ (constant 2016 US$ millions)