Paediatricians, gynaecologists and anaesthesiologists to be posted in 8 hospitals Tshering Zam, Thimphu
Oct 10, 2017
Eight district hospitals will receive a pediatrician, a gynecologist and an anesthesiologist each in the 12th Five Year Plan. Maternal and infant health is expected to improve with the placement of these health professionals.
This in turn is expected to help accelerate Bhutan’s drive to achieve the Sustainable Development Goals (SDG) Agenda 2030. “We are strengthening our district hospitals,” said Dr. Pandup Tshering, the Director General of the Department of Medical Services of the health ministry.
“So, after posting the specialists in the eight districts that we have identified, we will work towards the capacity development of our health workers. These will definitely help improve maternal and infant health.”
As health care improved, under-five mortality rate saw a decrease and so has the maternal mortality rate. However, institutional delivery remains a challenge.“We need to put in more effort to encourage women to come to hospitals for delivery,” said Dr. Pandup Tshering.
“Antenatal check up is another thing. They have to do it at least eight times.”
Other thing, Dr. Pandup said is monitoring the growth development of children until they turn five. He said children are brought to the hospital until they turn two because of the vaccinations. But after that, children are brought to the hospital only when they fall sick.
The health ministry says it is confident of achieving SDG Goal Agenda 2030. To streamline and discuss on the achievement and challenges in Asia Pacific Region, an exchange program was recently held in Manila in the Philippines.
Different records of live and stillbirths at relevant agencies
October 9, 2017
Hypertensive disorder, unfavourable intrapartum, infection, chronic maternal illness, postmaturity, congenital malformation, and alcohol are some of the factors associated with stillbirth, according to a study the health ministry conducted.
The ministry conducted the study among women who had stillbirths in 2015.
Health officials say that all deliveries after 28 weeks of gestation in 2015 were included as live birth and all outcome of pregnancy as a dead baby after 28 weeks of gestation were included as stillbirth.
The study observed that social factors like mother’s ignorance, poor family support, alcohol abuse, distance as a barrier, and unplanned pregnancy also contributed to stillbirth.
It also revealed that records of live and stillbirths with the maternal and child health (MCH), household survey and institutional delivery in the dzongkhags differ.
According to MCH record, the country had 11,122 live birth and 101 stillbirths in 2015, which is nine per 1,000 live births. Thimphu had the highest stillbirth with 17, followed by Samdrupjongkhar and Trashigang with 13 and 12.
Paro, Trongsa, Tsirang, and Wangdue had no stillbirth record in 2015, according to MCH.
The institutional delivery record shows the country’s stillbirth rate in 2015 was 8.4 per 1,000 live birth with 108 stillbirths and 11,126 live birth. Thimphu with 35 stillbirths is the highest among the dzongkhags. Chhukha and Mongar followed with 14 and 13 stillbirths.
Bumthang, Dagana, Gasa, Pemagatshel, Trashiyangtse, Tsirang, Wangdue and Zhemgang recorded zero stillbirth.
Annual household survey shows the country had 75 stillbirths in the same year with the highest stillbirth in Sarpang at 12. Samdrupjongkhar and Mongar had nine stillbirths each. Trashigang had eight.
With 8,902 live births, Bhutan’s stillbirth rate in 2015 according to the annual household survey was 8.4 per 1,000 live birth. Chukha, Dagana, Trongsa and Tsirang did not have any stillbirth.
About 49.6 percent of pregnant women delivered in referral hospitals; only 19.5 percent of them registered for antenatal care (ANC) in the referral hospitals.
Of 9.5 percent registering for ANC in BHU grade I, only 5 percent of them delivered in BHU I. Some 40 percent of the women registered for ANC in BHU grade II, of which only 9 percent delivered in BHU II.
The annual household survey information was unavailable for Thimphu and Phuentsholing, while some of the available information on other dzongkhags were incomplete. This is one of the limitations of the study.
A health official said MCH and institutional delivery records are maintained with the health centres while health staff conducts the survey, visiting households and questioning the household members. “There is the possibility of failure to capture all stillbirths.”
He said that there is a need for further study to validate the findings. “There seems to be underreporting, which should be validated by the study.”
A medical journal, Lancet Series estimated Bhutan’s stillbirth rate at 16 per 1,000 live births in 2015.
The study, the official said, is a part of Bhutan newborn action plan 2016 – 2023 during which the ministry aspires to reduce preventable stillbirth to 12.1 per 1,000 live births by 2023.
The official said that secondary data revealed a significant number of mothers drop out from the ANC. “Mothers were ignorant about early self-referral, which resulted in delayed help-seeking, especially following the decreased fetal movement, amniotic fluid leakage or commencement of labour.”
He said that some mothers visited ANC infrequently while others continued stressful physical activity even during late third trimester possibly due to poor family support and ignorance.
The study recommends maternal tracking and strengthening monthly reporting on live birth and stillbirth through institution of a surveillance system.
The health official said the ministry has initiated a web-based mother and child tracking system in a phased manner since last month. Over 150 healthcare providers have been trained in the country.
The ministry has also initiated the implementation of the newborn birth defects database surveillance system in Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu, and the regional hospitals in Gelephu and Mongar starting this month, which will include stillbirth and newborn in addition to birth defects surveillance.
The study recommended advocating risk of alcohol and smoking and its exposure to unborn, improving quality and coverage of ANC, promoting institutional delivery, strengthening MCH services monitoring and supervision both at central and district level, and rotating midwives posted at BHU grade II to hospitals to avoid loss of skills.
It used data from the annual household survey, MCH records and newborn delivery register in all health centres, and inpatient record of mothers who had stillbirth during her institutional delivery within 2015.
World Bank downscales growth projections
October 11, 2017
…on the back of delays in hydropower, GST and demonetisation issue
Slow progress and delay in the hydropower construction, demonetisation issue, and the introduction of goods and services tax (GST) in India is likely to disrupt Bhutan’s macroeconomic prospects and downscale economic growth projections.
The World Bank has revised the country’s economic growth projections from 9.9 percent to 6.8 percent in 2017. The 2018 growth projection was revised down from 11.7 percent to 7.7 percent.
Delay in hydropower is likely to have significant negative impact on growth, revenue and exports, according to the World Bank. This is according to a paper on economic update of the country titled ‘hydropower sector clouds macroeconomic prospects.’
A one-year delay in the completion will reduce GDP growth rate by 3–4 percentage points, exports by US$250–300M (about 50 percent of the current exports), and revenues from tax, dividend, and royalty by 0.5–1.0 percent of GDP.
How much should the country worry about public debt?
The World Bank team claims that the dominance of hydropower external debt means that debt sustainability is closely related to the sustainability of hydropower debt.
About 90 percent of hydropower external debt is financed by India with interest rates at 9–10 percent for the Punatsangchhu I and II and Mangdechhu projects.
The first interest and principal payments are expected in 2018. This timing is earlier than the scheduled commissioning dates of Punatsangchhu I and II, and construction costs are increasing.
However, it was stated that the Government of India covers both financial and construction risks of these projects and buys the surplus electricity at a price reflecting cost plus a 15 percent net return. “As long as the 15 percent net return is secured, while the delays affect economic growth, government revenues, and repayment capacity of non-hydropower debt, hydropower external debt is considered sustainable. Hydropower external debt is, therefore, unlikely to lead to a debt crisis.”
The loans from India led to an increase in external debt from US$2.3 B (119 percent of GDP) in June 2016 to US$2.5 billion (122 percent of GDP) in March 2017. “The increase in external debt requires careful monitoring, although the most recent debt sustainability analysis shows that Bhutan faces a moderate risk of external debt distress,” the paper stated.
Maximising access to non-debt financing such as foreign direct investment (FDI) and remittances would ensure stable financing for development and less reliance on debt financing.
While, the revenue and grants are projected to decline from 28.6 percent of GDP in 2017-18 to 21.6 percent in 2019-20, domestic revenues are projected to increase to 20.4 percent of GDP in 2018-19.
However, tax revenues are projected to decline from 13.9 percent of GDP in 2015-16 to 11.9 percent in 2019-20. It is mainly because of the decline in excise duty refund from India starting to take effect in 2018-19 because of the GST.
The decline in tax revenues is partly covered by the increase in nontax revenues due to profit transfer from the Mangdechhu Hydropower Project starting in 2018-19. Capital expenditures are also projected to decline significantly to 9.9 percent of GDP in 2019-20. “The decline is consistent with the government strategy to consolidate past investment in infrastructure and effective use of operations and maintenance expenditures.”
Because of the GST, Bhutanese products are becoming more expensive and Indian products cheaper.
For example, before the introduction of GST, Bhutanese products were subject to value added tax (VAT) at the point of sales in India. On products imported from India, excise duties and VAT were levied. Excise duty, which is about 10 percent of the domestic revenue, was later refunded by the Government of India to the Bhutanese government on an annual basis with a two-year lag. Now with the introduction of GST, Bhutan’s exports to India are subject to GST both at point of entry and point of sale in India. They are treated same as local goods in India. On the other hand, India’s export to Bhutan is zero-rated with no excise duty (except for five petroleum products).
This will potentially lead to an increase in trade deficits and fall in domestic revenue from excise duty refunds.
“As India accounts for about 90 percent of Bhutan’s international trade, GST is likely to affect the economy through trade and revenues,” the report stated. Moreover, there is still confusion about the implementation of GST, which has adversely affected trade flows.
The World Bank officials are of the view that delays in hydropower construction and increase in expenditures have left a resource gap in the budget. Unless financing sources are identified, the resource gap will lead to cut in expenditures, which will negatively affect growth and development.
According to the World Bank team, if trade disruptions caused by India’s GST continue, and given the country’s vulnerability to natural disaster affecting domestic connectivity, they are likely to have a negative impact on the economy.
Even in the financial sector, data show that growth rates of lending remained high until May 2017. However, lending growth is different among the major sectors. For instance, lending to services and tourism kept accelerating while lending to trade and commerce turned negative in November 2016. This is attributed to the India’s demonetisation.
BBS Inexcusable breaches of cell phone etiquette in meetings
Surjaman Thapa & Karma Wangdi, Trongsa
Oct 11, 2017
Fiddling with mobile phones during meetings is nothing uncommon these days with people having more access to smart phones. While many consider the act as inappropriate, others say it’s a sheer distraction when an important discussion is going on.
During the recent Dzongkhag Tshogdu in Trongsa, the scenario was of similar sort. While various issues and problems concerning the dzongkhag are being discussed, some officials were busy engaged with cell phones. The DT Chairperson Ugyen Tenzin had to repeatedly remind the members to refrain from using phones in the meeting.
“Using mobile phones is distraction when an important issue is being discussed. When you are occupied with your phone, you cannot focus on the discussion and as a result we cannot come up with fruitful resolutions,” added the DT Chairperson.
Officials from other dzongkhags also concurred with the DT Chairperson’s viewpoints.
“Unless there is something very important regarding the meeting, using mobile phones is not a wise idea. The very purpose of attending the meeting is to learn something and not to play with cell phones,” said Passang Dorji, Dzongrab of Pema Gatshel.
Some even suggest that cellphones must be banned in meetings since verbal warnings may not be of much help.
BBS Farmers in Bumthang revive buckwheat cultivation
Oct 12, 2017
Buckwheat cultivation in Bumthang has been on a declining trend over the last few decades. However, the district is now seeing a revival in the cultivation of the traditional crop. Thanks to an initiative by the Dzongkhag Agriculture Sector and the National Biodiversity Centre which aims at diversifying and marketing buckwheat products.
Jalikhar Village, a few kilometres away from Chamkhar town has the highest cultivated area of buckwheat crops in Chhoekhor Gewog. The fields are owned by a group of farmers who are actively engaged in the project. Other farmers who are not in the group have also started growing buckwheat on a wider scale. This is because of an improved market for the crop.
“People were more involved in potato cultivation and that resulted in shortage of buckwheat flour during rituals. So now, we are focusing more on buckwheat cultivation,” said a farmer named Nazom of Sanam Chithuen Rangzhin Tshogpa.
Sanam Chithuen Rangzhin Tshogpa was established in 2010 with the mandate to diversify crop cultivation. Since then, it has been making significant strides in reviving buckwheat crop in the district. Buckwheat is used for making cookies, puta (bumthap cuisine), and pancakes. Its husks are also used for making pillows which have become popular among the tourists.
“We now think that we have achieved what the Agriculture Ministry and ourselves targeted for. For example, in the past, a drey of buckwheat used to get only Nu 15. Now, it costs Nu 50. We are happy we have been able to revive the crop cultivation,” said Chairperson of Sanam Chithuen Rangzin Tshogpa, Sonam Tobgay.
Agriculture officials said crop diversification is crucial for farmers.
“If we are to develop a new variety of the crop, we need the genes of the aboriginal variety as well. The other thing is that due to climate change, some of the crops don’t grow as it used to in the past,” said Gaylong, the Dzongkhag Agriculture Officer. “It’s important that we have varieties of crops in cultivation so that if one of the crops has lesser yield, the other can substitute it.”
Last year, Bumthang cultivated about 1000 acres of buckwheat which is the highest acreage of crop cultivation in the district. With more farmers involved in buckwheat cultivation now, the crop is set to become the most essential cereal for the farmers of Bumthang once again.
BBS Paro International Airport gets a makeover
Sangay Chezom, Paro
Oct 12, 2017
Paro International Airport is getting a facelift with construction of parallel taxiway and re-modification of departure terminal building. The new arrangement is being made to improve efficiency in handling more number of aircrafts by easing air traffic.
The taxiway will become operational by February, next year and will be used when a plane prepares to take off to reach the end of the runway without having to wait for another flight which is about to touch down. Airport officials said the new facility will help them manage over 45 flights per day.
“Yes, we will definitely handle 45 flights in a day. Earlier especially during wind curfew in February till May, we had very limited operating hours. So we could only handle around 15 flights,” said Karma Wangchuk, Director of Department of Air Transport. “There are talks that other airlines may land here in future. a few private jets have already landed here.”
The parallel taxiway is being built with fund of over Nu 160m. Under the re-modification of departure terminal building, more number of check-out counters will be set up to cater to increasing number of passengers. The work is expected to be complete by July, next year.
“With this current building, we can handle over 200 passengers at one time, but once the terminal is extended, we can definitely handle over 700 passengers at one time. We will have three boarding gates like each dedicated to each Sector,” said the Director. “Just now we have one boarding gate and when over passengers for over two flights check-out all together, it becomes crowded.”
Air Transport Department also has plans to build new professional cargo terminal equipped with all the required facilities. It will even relocate the substations to expand the parking lounge near the arrival terminal.
Paro International Airport is the sole international airport in the country. It became operational in 1983.
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