Bhutan

2. TRENDS IN SOCIOECONOMIC DEVELOPMENT

2.1 Economic trends

The economy of the country steadily grew from 6.5 percent in 1997/98 to 7.3 percent by 2001/02. Real growth in gross domestic product (GDP) has stabilized at 5.6 percent per annum. In more recent years, GDP is well above the estimated population growth rate of 2.5 percent. The GNP per capita in 2002 was US $ 835.

The private sector development has been slow. The growth has been constrained by a number of factors such as lack of entrepreneurial expertise, high costs of credits and shortage of both skilled and unskilled labour. Hence even in health, private sector is limited to few pharmacy shops in urban areas. 

The health and education sectors comprise 25 percent of public spending with health accounting for around 10 percent in 2003, an increase from 6.5 percent in 1999. (The total health care expenditures represent 3.1 percent of GDP).

Bhutan National Human Development report for year 2000 puts Bhutan in the category of medium human development countries in the South-East Asia region along with Sri Lanka and Maldives with a human development indicator of 0.581 in 1998. According to Human Development Report 2006 shows the HDI 0.538 .

The policy of the RGOB (Royal Government of Bhutan) is to pursue and provide free health care services to its population from basic primary to tertiary care.

Related Links

      International reports on Bhutan - MOF

     Key Development Data & Statistics - World Bank

     Human Development Trends - HDI

     Economic and Social Survey of Asia and the Pacific - UNESCAP

2.2 Demographic trends

During 2005, the crude birth rate was 20 and crude death rate was 7 per 1000 population. Total fertility rate was 4.7 and there is a general decrease in the population growth rate from 3.1 in 1994 , 2.5 in 2002 to 1.3 in in 2005. The sex ratio of males per 111 females

In 2005, the population  0-14 years was 33.1 percent; 15-64 years population was 62.2 percent and population 65+ years and above was 4.7 percent.

The Life expectancy at birth is estimated to be 66.1 years with 66.2 years for females and 66 years for males in the year 2000. It has increased by 18 years in past 20 years.

The IMR is reported to be 40.1 per 1000 live births for the year 2005.  It has decreased from 102.8 for the year 1984.

The population of the country was estimated to be 637,000 in the year 2006. The population is largely rural with 69.1 percent of the population living in villages despite a growth in the urban drift in the recent years

Related Links

     Bhutan Health Management and Information System

     Population and Housing Census of Bhutan 2005

     The world health report - WHR

2.3  Social trends

Literacy: In 2000, Bhutan had one college with 385 educational institutes around the country, which gave the country gross enrolment rate of 89 percent with the adult literacy rate of 47.3 percent. This shows a great progress over the literacy rate of 23 percent in 1980. In 2003, schools were few and far from the homes. Going to school involved travelling through jungles for hours. Hence, initially more boys got chance to go to school, as parents felt that it would be too tough for the girls. Due to this reason, the school enrolment in the first two-three-plan period showed a bias in favour of male student. However, presently the school enrolment ratio between male and female has become almost at par with each other.

There are 252 primary education institutions, 28 secondary and 8 higher education facilities in Bhutan in 1999 (Asian Development Bank: Bhutan-1999 Country Portfolio Review and Country Programming Confirmation for 2000 Mission, Memorandum of Understanding).

Related Links

      Ministry of Education - Bhutan

     Institute of statistics- UNESCO

      WB

2.4  Food supply and nutritional status

In Bhutan, around 8.5 percent births are low weight among hospital births (less than 2500 gm) (Bhutan Census)

The Royal Government is paying special attention to problems related to nutrition. Several nutrition and micronutrient deficiency studies have been conducted over past decade. In 1999, the national anthropometric study was conducted. The results of the study indicate marked improvement in the nutritional status of the under five children as compared to the 1989 national nutrition survey (refer table)

Table 2.4.1: Percentage of under five children who are underweight, stunted and wasted

The 1996 IDD study “tracking progress towards sustainable elimination of IDD” revealed Total Goitre Rate (TGR) of 14 percent, Median Urinary Iodine level of 298 m/L and iodated salt coverage of 82 percent. Micronutrient deficiencies like iodine deficiency disorder has already been eliminated in Bhutan since 2003 as certified by International Council for the Control of Iodine Deficiency Disorder (ICCIDD), UNICEF, WHO.  Bhutan is the first country in South East Asia to have eliminated IDD as public health problem (Annual Health Bulletin, 2003, Royal Government of Bhutan, Ministry of Health).   

However, iron deficiency is still widely prevalent. According to a haemoglobin study conducted for school children in 2002, 58.6 percent adolescent (school children between the ages 5-15 years) are anaemic.

In the 1990s, 60 percent of pregnant women were also anaemic. To address this situation, the Health Sector adopted the policy of universal iron supplements to all pregnant women during pregnancy and lactation.

It is known that in Bhutan mothers introduce solid food and other feeds early to infants, whereas the ideal practice is to promote exclusive breastfeeding at least for the first four months.  National Health Survey 2000 reported that exclusive breastfeeding was practiced in 42 percent of the cases.

Related Links

     Child Health and Nutrition

     Nutrition for Health and Development – WHO/SEARO

     Nutrition for Health and Development – WHO/HQ

2.5  Lifestyle and Risk Factors

Tobacco consumption, chewing and smoking, once very common is now on the decline. It has been made possible due to strong advocacy and intervention activities that the health sector is carrying out.

The complications during pregnancy due to abortion have increased from 5.4 percent in 2001 to 30.54 percent in 2003 (Annual Health Bulletin, 2003, Royal Government of Bhutan, Ministry of Health).

Another health hazardous habit among the people of Bhutan is liberal consumption of liquor. It is also on decline due to the publicity promoting prohibition by the Government. 

Basically an agrarian society, people still depend largely on agricultural activities in the districts. In the main towns, people work in Government and private offices and there is a general lack of physical exercise in most of them.

Archery is still the most popular sport although the traditional bamboo bow and arrows are manufactured abroad. Football is played in schools and towns from time to time in particular seasons.

Rice is the main staple diet followed by maize. Wheat, barley, buckwheat are other food items along with vegetables and meat. Traditionally, Bhutanese diet contains more fat from items like pork and butter and most curry items are seasoned with heavy doses of chilli. The fat intake is also getting reduced-especially in towns as the people find it difficult to digest fats with the sedentary lifestyle they lead.

Chewing dama, beetle nut with a leaf and some lime, is a common habit, which is a part of the Bhutanese tradition. Most of the formal get-togethers are punctuated with this item. But today this habit is more common with the elderly people, although the younger generation too indulges in this habit.

Related Links

     Department of Public Health - Bhutan

     Arsenic - WHO/SEARO

     Substance Abuse - WHO/SEARO

     Tobacco - WHO/SEARO

     Smoking - WHO/HQ

     Alcohol – WHO/HQ