Before the inception of the First Five Year Plan, there were 4 hospitals a few dispen-saries and a Leper Colony with 120 patients. The Medical staff was very meagre, there were only 2 Doctors in two hospitals and the remaining 2 hospitals and all the dispensaries were under the charge of compounders.
Primarily the task at the start of the first plan was:
(i) Establishment of a Directorate of Health Services for proper organisation and the administration of the department and proper guidance of the development activities.
(ii) To improve the working of existing hospitals and dispensaries and to open 2 more dispensaries.
(iii) Start one Mobile dispensary.
(iv) Initiate measures to control and eradicate communicable diseases such as small- pox, malaria, tuberculosis, leprosy, V.D., goitre and helminthiasis.
(v) To provide protected water supply at important places.
The major difficulties faced by the department were:
I. Absence of proper communications and transport.
II. Shortage of qualified technical personnel at all levels from Nurses and Com- pounders upwards to man the hospitals and dispensaries.
III. Shortage of adequate accommodation for hospitals and dispensaries as well as for the staff and difficulties of quick construction due to shortage of labour and materials.
Despite these handicaps considerable progress has been made, the Directorate has been established under the direct control of a Director. The existing 4 hospitals at Thimphu, Paro, Wangdiphodrang and Tashigang have been improved and the staff strengthened.
The hospital buildings at Thimphu have been renovated and the hospital equipped with modern equipment including X Ray Plant.
The Technical Committee had recommended the improvement of all the existing 11 dispensaries and establishment of 2 new dispensaries at Ghasa and Shemgang. As a matter of fact in the First Plan 13 dispensaries have been established, including the 2 recommended by the Technical Committee.
A Mobile dispensary as recommended by the Technical Committee has been established for operating in Eastern Bhutan with Headquarters at Khaling on Tashigang Samdrup Jongkhar Road.
2 New hospitals have been established at Samchi and Sarbhang.
2 Stretcher carrying Jeeps were purchased and converted to Mobile dispensaries and a Lady Health Visitor has been appointed to work with the Mobile dispensary in Tashigang area.
A leper hospital has ben constructed at Gidakom near Thimphu at a cost of Rs. 1,41,000, to accommodate 50 indoor patients and also to provide out patient treatment. Another colony for 50 patients has also been established in hutments at Kurteo. It is at present looked after by a Compounder specially trained in leprosy work. lt is proposed to appoint a Doctor during the Second Plan period. At the leper hospital at Gidakom, surgical treatment is also being proposed in the Second Plan. The Gidakom hospital is supervised by a Doctor from the Lprosy Mission.
Measures have been initiated for the control and eradication of communicable diseases.
(a) Smallpox
20 Vaccinators have been trained during the Plan period and posted at the different hospitals/dispensaries for mass vaccinator work.
(b) Malaria
The National Malaria Eradication Programme authorities of the Government of lndia have lent Bhutan a team for working in Southern Bhutan where Malaria is most prevalent. The headquarters of this team were established at Sarbhang in 1964. They have started a Laboratory at Sarbhang with sub centres at 10 different location for spraying. ln the Second Plan it is proposed to expand the number of centres for spraying to 16.
(c) Tuberculosis
Tuberculosis wards have been attached t each hospital for indoor treatment of patients. The construction of Tuberculosis hospital at Samchi was started in the First Plan and an expenditure of Rs. 1,83,900 as incurred during that period. The hospital and staff quarters are nearing completion and it is expected that it will start functioning from the Second Year of the Second Plan. Necessary provision for staff etc., has been made.
A B.C.G. team from West Bengal has also started working periodically in Bhutan for B.C.G. vaccination. The team has so far tested 16,073 persons of which 6,495 were found to be positive 6,465 of these cases have been vaccinated with B.C.G.
(d) Goitre
The sale of iodise,salt at the subsidised rates has been introduced all over the country and the entry of the common salt has been banned.
Water Supply
The Technical Committee had recommended protected water supply in 6 places namely, Samchi, Phuntsholing, Sarbhang, Deothan, Thimphu and Wangdiphodrang. The implemen-tation of these recommendations has been partially achieved. In the Second Plan provision for water supply has been made under the Bhutan Engineering Department through selection of sources and technical guidance from the Public Health Services will be given then at the time of starting projects.
As against the total proposed outlay of Rs. 83.52 lakhs, the expenditure incurred during the First Plan was Rs. 57.17 lakhs.
Objectives of Second Plan
The main objective in Second Plan is to improve the general level health and to expand basic health service coverage to reach all the people. Broadly it is intended to im-prove and strengthen the staff in the existing dispensaries and to open 5 new dispensaries it is also proposed to considerably reinforce the staff and facilities available at the Central Hospital at Thimphu and a new hospital building with accommodation for 100 patients is planned. (In the Second Plan period half the accommodation for bd strength and most of the other facilities will be completed).
It is also proposed to establish one additional hospital at Phuntsholing with 20 bed and to improve the working of the existing hospitals at Samchi Sarbang and Tashigang.
The medical coverage will also be extended by deployment of 4 mobile units for which vehicles have been provided by the Government of the United Kingdom under the Colombo Plan. One of these vehicles will be placed at the disposal of the Health Visitor and 3 others will operate from the hospitals at Thimphu, Paro and Sarbhang.
Considerable expansion of the preventive schemes is also contemplate under all the heads.
Due to the difficulties of obtaining labour, and materials and our limited capacity for construction, extension and improvement of the existing hospitals is considerably hampered by shortage of staff quarters. In this plan along with the expansion of the hospital and dispensary buildings, limited number of staff quarters to meet about 50 % of our requirements has been proposed.
Details for each individual schemes are given separately.
Department ............. Health Services
Scheme No. ............. I
Name of the Scheme ..... Direction
Proposed Outlay ........ Rs. 9.109 lakhs (say Rs. 9.11 lakhs).
The Present staffing pattern of the Directorate is:
Director of Health Services ......... 1
Superintendent of Health Services ... 1 (on deputation)
Office Assistant .................... 1
Accountant .......................... 1
Upper Division Clerks ............... 2
Lower Division Clerks ............... 2
Drivers ............................. 2
Class lV staff ...................... 3
It is Proposed to add the following additional staff during the Second Plan:
Medical Officer/Registrar ..... 1
Stenographer .................. 1
Lower Division Clerk .......... 1
Class lV Staff ................ 1
With the expensive activities of the department and the necessity for constant and effective supervision of Projects in the field during the implementation stage, it is felt that both the Director and Superintendent of the Health Services should be relieved of the necessity for continues attention to office routines. It is, therefore, proposed to appoint a Medical Officer with experience of administration of Health Service or an experienced and qualified Registrar to look after the routine work at the Directorate Headquarters. The expansion of the rest of the establishment is marginal and just sufficient to meet the expan-ding work load.
Detailed break up of expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. II
Name of the Scheme ..... Medical Supply Depot (Phuntsholing)
Proposed Outlay ........ Rs. 1.006 lakhs (say Rs. 1 lakh).
The Medical Supply Depot was established during the First Plan period at Phuntsho-ling to meet the needs of different dispensaries and hospitals from the Central Stores, as the difficulties of transport made the supply of medical stores directly to individual units from suppliers very irregular.
The store depot will maintain stocks for four months of most of the major requirements, of the various hospitals. Separate provision for procurement of stock has not been made under this Scheme as funds have been provided in individual units.
It is felt that in order to maintain adequate reserve stocks, it would b desirable to have a permanent advance of about Rs. 50,000 available with the Directorate for this purpose, which would not really be a liability on the Plan as it would be recouped as supplies are drawn by the individual unit.
Provision for a trained Store Keeper with experience of Medical Stores has been made in the current Plan and funds have been provided for the construction of staff quarters. The store building already exists.
Detailed break up of expenditure is in Vol. No. II.
Department .......... Health Services
Scheme No .............. III
Name of the Scheme ..... Expansion of Thimphu General Hospital.
Proposed Outlay ........ Rs. 25,921 lakhs.
It is proposed to expand the Thimphu Hospital to a General Hospital with 100 beds and specialised coverage as well as facilities for major surgery. In the First Plan provision was made for Rs. 19.70 lakhs for the extension of this hospital. This scheme could not be implemented as the government's decision on the lay out of the new township at Thimphu had not been finalised.
In the Second Plan, bearing in mind our limited constructional capacity, part cons-truction is contemplated. This will provide most of the operating and service facilities and accommodation for about half the bed strength (50 beds). When this building is completed the equipment and staff will be moved there from the existing building near the Dzong.
Specialised services particularly surgical will also be provided in the hospital and neces-sary provision for the requisite qualified staff has been made in the plan.
The existing staff is:
Medical Officer .......... 1
Dental Surgeon ........... 1
Compounders .............. 5
Matron .................. 1
Senior Nurse ............. 1
Auxiliary Nurses ......... 3
Assistant Nurses ......... 2
Clerk .................... 1
Driver ................... 1
Class IV Staff ........... 9
The additional staff proposed in the Second Plan which will probably be recruited in the Second year of the Plan is:
Surgical Specialist ....................... 1
Medical Specialist ........................ 1
Pathologist ............................... 1
Medical Officers (General duties) ......... 2
Senior Nurses ............................. 2
Junior Nurses ............................. 2
Assistant Nurses .......................... 3
Class IV Staff(Dhobi, Mali, Cook etc.) ... 16
Detailed break up of the expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. IV
Name of the Scheme ..... Improvement of existing Hospitals.
Proposed Outlay......... (a) Tashigang Hospital Rs. 5.674 lakhs.
(b) Samchi Hospital Rs. 5.896 lakhs.
(c) Sarbhang Hospital Rs. 5.899 lakhs.
Total Rs. 17.470 lakhs.
In the Second Plan, it is proposed to improve the three existing hospitals at Tashigang, Samchi and Sarbhang by:
(a) providing modern instruments and equipments,
(b) installation of X Ray plants,
(c) augmentation of the staff by providing at least 2 Doctors (one with surgical expe-rience) and bringing the nursing staff and technicians upto requisite strength. Renovation and improving of the existing hospital buildings and provision of a certain amount of residential accommodation for the staff (50 % of the requirement) is also planned.
The present strength is:
(a) Tashigang
The addition staff proposed are:
(a) Tashigang
Detailed break up of the expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. V
Name of the Scheme ..... Establishment of new hospitals
Proposed Outlay ........ Rs. 8.59 lakhs.
Under the Second Plan a new 20 bed hospital is proposed to be established at Phuntsholing.
At present there are only two hospitals catering for Southern Bhutan, one at Samchi and the other at Sarbhang. Phuntsholing is the main entry point for Thimphu and Paro. There is a large floating population and constant traffic of visitors rom the plains of Assam and Bengal. lt is necessary to locate a hospital at this place both to cater to the needs of our staff stationed there, which is sizeable, as well as, to cater to transients and to prevent import of any communicable diseases from the plains.
The staff proposed is:
Medical Officer .............. 1
Compounder ................... 1
Junior Nurses ................ 2
Assistant Nurses ............. 2
Lower Division Clerk ......... l
Vaccinator ................... 1
Class IV Staff (Cook etc.) ... 5
Provision has been made for construction of the hospital buildings and part of the residential accommodation required for the staff. Provision has also been made for equip-ment and furniture for the hospital.
Detailed break up of the expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. VI
Name of the Scheme ..... Civil Annexe to Border Road Hospital Deothang).
Proposed Outlay ........ Rs. 99 lakhs.
The Border Roads Organisation has a well equipped hospital at Deotkang, which is the Headquarters of the Task Force Commander, Dantak. They have been treating civilian patients in this hospital but they have no women staff for looking after women patients.
The Commander has agreed to the hospital providing out patients treatment and also treatment of indoor patients, if we can construct a ward and provide one Junior Nurse They will levy capitation charges on the normal rates prevailing in Defence Services hospitals for non defence personnel.
In the scheme, provision has been made for the construction of a ward and quarters for the nurse. Provision has also been made for furniture and equipment for the ward. No provision has been made for major hospital equipment or for diet or medicine charges.
Lump sum provision to meet capitation charges has been included.
Detailed break up of the expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. VII
Name of the Scheme ..... Improvement of Existing Dispensaries
Proposed Outlay ........ Rs. 24.25 lakhs
In the Second Plan period it is proposed to improve medical cover provided by the 25 existing dispensaries by providing Doctors at the more important centrally located dis-pensaries and slightly augmenting the staff.
There are at present three doctors in dispensaries at Gaylegphug, Paro and Byagar. We propose to appoint two doctors in the Second year of the Plan and six doctors in third year of the Plan at Chirang, Mongar, Sibsoo, Chengmari, Surey, Dungsam, Yangtshi and Gomdar.
In addition two Junior Nurses will be appointed one each at Byagar and Mongar in the Second and Third year respectively.
The present staff is as follows:
Medical Officers ................ 3
Compounders ..................... 37
Assistant Nurse/Vaccinators ..... 25
Class IV Staff .................. 27
Dresser ......................... 1
Additional staff for the Second Plan as proposed is:
Medical Officers ..... 8
Junior Nurses ........ 2
Class IV Staff ....... 8
Provision has been made for expanding the existing facilities in the more important dispensaries by providing four emergency beds and also additional equipment in the various dispensaries.
Detailed break up of the expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. VIlI
Name of the Scheme ..... Establishment of New Dispensaries
Proposed Outlay ........ Rs. 2.996 lakhs (say Rs. 3 lakhs).
With the growing consciousness of the people regarding benefits of proper medical care a need for more dispensaries in the interior particularly in Northern and Eastern Bhutan is felt.
In the Second Plan period it is proposed to establish five new dispensaries to meet this growing needs. The location will be decided in due course.
The staff proposed for each dispensary is:
Compounder ......... 1
Vaccinator ......... 1
Class lV Staff ..... 1
Provision has been made for the construction of the dispensary buildings. A limited amount of staff accommodation, furniture and equipments for the dispensaries has also been provided.
Detailed break up of the expenditure is given in Vol. No. II.
Department .......... Health Services
Scheme No. ............. IX
Name of the Scheme ..... Leper Colonies
Proposed Outlay ........ (a) Gidakom Rs. 5,233 lakhs
(b) Kurteo Rs. 2.969 lakhs (say Rs. 2.9 lakh)
(c) Grant in aid to Parkijuli Leper Mission Rs. 1 lakh.
Total Rs. 9.20 lakhs.
There are two leaper colonies (i) at Gadakom near Thimphu and (ii) Kurteo. In addi-tion the Parkijuli Leper Mission has agreed to establish a colony in Tashigang area and take full responsibility for it.
We propose to give them a grant in aid of Rs. 25,Q00.per year.
(a) Gidakem Leper Colony
The colony was established during the First Plan and a certain amount of construction was done under the First Plan and is under progress. About 2. 1akhs will be required for the purpose during the Second Plan period.
The management of the hospital is in the hands of Leprosy Mission Purulia, who have posted one Doctor (Dr. Reidel) as the Superintendent of the Hospital. All the staff for the hospital (except one compounder and one driver and three Class IV staff which are already in existence) will be the responsibility of the Mission. The Government of Bhutan will be responsible for bearing the expenditure on transport (one Jeep for the Superintendent) and transportation of rations and medical stores.
(b) Kurteo
Hutted accommodation for 30 patients has been provided at the colony in Kurteo, which is at present under the charge of a Compounder.
The incidence of Leprosy in this area (Eastern Bhutan) is rather high. In the Second Plan, it is proposed to establish a 50 bed hospital at Kurteo under a qualified Doctor with special training in Leprosy work.
(c) Parkijuli Lepr Mission
Parkijuli Leper Mission has agreed to establish a leper clinic cum hospital at Riserboo in Tashigang District. They will meet most of the expenditure on construction and running of the Mission. We propose to give a grant in aid towards procurement of medicines and feeding of patients to the tune of Rs. 25,000 per year.
Detailed break up of expenditure is in Vol. No. II.
Department ............. Health Services
Scheme No. ............. X
Name of the Scheme ..... Mobile Units
Proposed Outlay ........ Rs. 2.43 lakhs.
One Mobile Unit is already operating in Eastern Bhutan under the control of a Lady Health Visitor with Headquarters at Khaling. Three more will operate with the hospitals at Thimphu. Sarbhang and Paro as bases. No additional staff has been provided for these three units, as hospital staff will be utilised for this purpose. Provision for the maintenance of the vehicles and supply of drugs for three units is also included in the provision for the hospitals.
The unit at Khaling was upto now operating with stretcher carrying Jeeps, purchased by us. It has now been equipped with one Land Rover specially equipped as a Mobile Dis-pensary/Ambulance. Three other Mobile Units will also be provided with similar vehicles. The vehicles were obtained from the Government of the United Kingdom under the Colombo Plan.
Present staffing pattern for the unit at Khaling is :
Lady Health Visitor ... ... ...1
Driver ... ... ... .. 1
Class lV Staff ... ... ... ... 2
It is proposed to provide one additional Junior Nurse to assist the Health Visitor. Provision for Drivers for the Mobile Units based at Thimphu Paro and Sarbhang have been included in this scheme.
The construction of accommodation for the unit at Khaling which is in progress has also been provided for in this scheme.
Detailed break up for the expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. Xl
Name of the Scheme ..... Control and Eradication of communicable diseases
Proposed Outlay ........ (a) Malaria Eradication Rs. 27.39 lakhs
(b) T.B. (Curative) Rs. 3.296 (say Rs. 3.30 lakhs).
(c) T. B. (B. C. G.) Rs. 5.69 lakhs.
(d) Goitre control Rs. 2.846 lakhs.
(e) Trachoma Rs. 1.49 lakhs.
Under this scheme action for the eradication/control of communicable diseases has been planned. The projects contemplated are:
(a) Malaria Eradication
The National Malaria Eradication Programme team sent by the Government of India have been working in Southern Bhutan with their Headquarters at Sarbhang since 1964. They have during the period established 10 spraying centres which will in the Second Plan reach the consolidation stage.
Six more centres are proposed to be established in the Second Plan in keeping with the recommendation of the Malaria Survey team which carried out a survey in 1962. To imple-ment this programme, there will be considerable increase in staff particularly in the field staff.
The insecticides and drugs are provided by the Government of India. However, pro- vision has been made for equipment and transport cost. Present staff employed on the Malaria Eradication Programme is:
Medical Officer ............ 1
Accountant ................. 1
Typist ..................... 1
Store Keeper ............... 1
Laboratory Technicians ..... 4
Junior Inspectors .......... 9
Mechanic ................... 1
Drivers .................... 3
Senior Field Workers ....... 4
Class IV Staff ............. 5
Field Workers .............. 11
In addition 16 seasonal Senior Field Workers and 120 seasonal Field Workers are employed for 8 months during the spraying season. About 20 porters are also employed seasonally.
With the establishment of 6 more spraying centres in the Second Plan the following additional staff is being provided for:
Assistant Unit Officer ........ 1
Senior Malaria Inspectors ..... 4
Junior Malaria Inspectors ..... 2
Class IV Staff ................ 2
Senior Field Workers .......... 6
Field Workers ................. 6
In addition six Senior Field Workers and 84 field workers and porters will be employed during the spraying season.
Provision bas been made for the construction of requisite stores and office buildings and limited staff quarters.
(b) Tuberculosis (curative)
A Tuberculosis hospital has been established at Samchi and construction of a major portion of the buildings was completed in the First Plan at an approximate expenditure of Rs. 1,83,900. As soon as the staff has been obtained, the centre will start functioning. In view of the anticipated difficulty of obtaining qualified and experienced personnel, provision has only been made in the second year of the Plan.
The incidence of T. B. is rather high particularly in the Gurkhali inhabitated areas of Southern Bhutan. t is for this reason the hospital in located at Samchi is Southern Bhutan.
The staff proposed is:
Medical Officer (trained in T. B. work) ... 1
Compounder ................................ 1
Junior Nurses ............................. 2
Assistant Nurses .......................... 3
Class IV Staff ............................ 3
The staff of the T. B. hospital will also have the assistance of the main hospital at Samchi. Provision for equipment has been made. No provision for the buildings has been made as they have been more or less completed in the First Plan.
(c) Tuberculosis (preventive B. C. G. Team)
A B. C. G. team on loan from West Bengal is at present carrying out B. C. G. vaccina-tion in Bhutan. In the Second Plan, it is proposed to raise two teams to continue this work. One Medical Officer, specialised in B. C. G. work to supervise both the teams has been provided in the plan.
It is proposed that the teams will visit each village test and vaccinate and compile records.
Staff proposed for each team is as follows:
Team Leader (to act as l/cs of the M. O. for supervision and guidance 1 of the technicians in their day to day work) ..... 2
Technicians ..... 3 per team.
In addition a Lower Division Clerk, a driver and to Class IV staff have been provided at Headquarters for the Medical Officer in charge.
Provision has been made for office and store buildings and limited staff quarters as well as for procurement of equipment and drugs such as field workers haver sacks, vaccine etc. and purchase of one Jeep for the Medical Officer's tours.
(b) Goitre Control
Iodised salt for Goitre control is imported from lndia and distributed throughout Bhutan. Godowns for the storage of salt have already been constructed at Phuntsholing, Gaylegphug and Deothang. The construction of a fourth godown at Sarbhang is proposed in the Second Plan. The godowns will be under the charge of a Store Keeper with one Chowkidar. The Civil Sub-Divisional Officers of the respective areas have been entrusted with the supervision of the sales and maintenance of accounts for which they will be given an honoraria of Rs. 50 per month. The sale of iodised salt to the Public will be subsidised to keep the price at par with that of common salt. The expected cost of subsidy is about Rs. 15,000 a year. Provision for the subsidy and for the construction of a godown at Sarbhang as well as accommodation for staff at all the places has been made in the Second Plan.
(e) Trachoma Control
It is proposed to form one team to be engaged for Trachoma control, a disease which is very prevalent in Bhutan.
The staff proposed is:
Medical Officer ..... 1
Compounder .......... 1
Driver .............. 1
Class IV Staff ...... 2
Provision has been made for the construction of staff quarters and the cost of one Jeep.
With the anticipated delays in obtaining qualified personnel, it is expected that the team will only be able to function in the Second Year. Provision has, therefore, been made from the Second Year.
Detailed break up of the expenditure is given in Vol. No. II.
Department ............. Health Services
Scheme No. ............. XII
Name of the Scheme ..... Training Programme
Proposed Outlay ........ Rs. 0.73 lakhs.
The training of literate Bhutanese candidates for various technical courses was the responsibility of the Education Department in the First Plan.
In the Second Plan, it is proposed that each department should obtain suitable candi-dates in consultation with the Education Department and arrange their own training courses, either in their own establishments in Bhutan or in establishments in lndia.
As the Education Department has made provision in the first year for those trainees, already undergoing training in Medical courses, provision has only made from the second year onwards.
During the plan period, it is proposed to train 12 compounders, 16 auxiliary Nurses 15 Vaccinators, 4 dressers, 2 X Ray technicians and 2 Laboratory technicians.
Provision has been made at the rate of Rs. 100 per month as stipend for the compounders, nurses and technicians and at the rate of Rs. 80 per month for 9 months a year in the case of vaccinators and dressers who will mainly be trained in our own establishment.
Provision has also been made for expenditure on R. A. Uniforms for nurses and incident-al charges for sending Compounders, Nurses and Technicians to suitable institutions in lndia for training.
Detailed break up of the expenditure is given in Vol. No. II