The number of averted cases was then multiplied by the average unit cost at each facility type, producing the cost saved in Bhutanese ngultrum- ngultrums were then converted to U. Managing infectious diseases cost around Nu 1.2B (26 percent).

https://doi.org/10.1007/s10900-004-1960-4. The major cost drivers, according to the study were inpatient care constituting 49 and 58 percent of the CHE, followed by outpatient care constituting 13 and 24 percent in 2014-15 and 2015-16. WHO provided financial and technical support for the study. With the support of the Bhutan Ministry of Health, we collected hospital and clinic admissions data for the following illness/maladies: conjunctivitis, scabies, diarrhea, dysentery, wound care (bites and stings, contact with heat, work related injury, and other injury), depression/anxiety, dental caries, and skin infections.

Dzongkhag wise, Thimphu reported the highest CHE, followed by Chukha, Mongar and Sarpang. Similarly, a 2018 systematic review, which highlighted Pakistan, Burma, Cambodia, and Nepal also found improved mental health for individuals who had support from CHWs [14]. Retrieved February 12, 2020, from https://www.who.int/choice/country/npl/cost/en/. Due to the unique healthcare structure of Bhutan, the country remains a powerful model for better understanding the impact that VHWs have on a national scale as well as on the communities that these health workers serve. The study states that this is because of the location of major hospitals in these dzongkhags. A 2015 literature review of CHWs in India, Pakistan, Bangladesh, and Nepal shows that these health workers reduced costs when compared to standard of healthcare for both patients and providers with regards to a variety of health services provided (i.e.

Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan, https://doi.org/10.1186/s12889-020-09347-4, https://www.who.int/hrh/documents/community_health_workers.pdf, https://www.solvingdisparities.org/sites/default/files/FA%20CHW%20Brief%20-%20Final%20(1).pdf, https://doi.org/10.1007/s10900-004-1960-4, http://www.health.gov.bt/wp-content/uploads/ict-files/2015/11/The-cost-of-healthcare-services-in-Bhutan.pdf, https://doi.org/10.1186/s12960-017-0192-5, https://doi.org/10.1186/s12960-015-0070-y, www.ncbi.nlm.nih.gov/pmc/articles/PMC4557864/, https://www.who.int/choice/country/npl/cost/en/, https://www.who.int/choice/country/ind/cost/en/, http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102009005000016&lng=en&nrm=iso&tlng=en, https://www.who.int/mediacentre/news/notes/2007/np25/en/, https://doi.org/10.1186/s12888-017-1379-y, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803443/, https://doi.org/10.1186/s12960-015-0094-3, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. CHWs in a variety of economic and social settings have shown to increase access to health resources in a cost-effective manner. Households contribution to CHE was about 20 percent in both and rest of the worlds contribution was about 5 percent. (2010a, December 6). Independent of the healthcare savings associated with VHWs, a substantial effort should still be undertaken to ensure that the Bhutanese VHWs program is revitalized, as it expands vital health resources to key communities, serves as an economic buffer for vulnerable groups, and aids to reduce disease morbidity. Asia Pacific Observatory Health Syst Policies. Effectiveness of a community health worker program on oral health promotion. Lastly, it is important to note that there is significant benefit to communities acquiring medications and wound care rapidly as the likelihood of disease progression and disease morbidity are significantly hampered when treatment is made readily available. Village health workers (VHWs) in Bhutan play an all-encompassing role in supporting the health of their communities. The authors read and approved the final manuscript. The cost-savings associated with these health workers is likely to become more pertinent as the nation begins to develop and healthcare costs increase. Using the latest data on health center admissions, we calculated the number of potential disease cases averted by increasing the average number of VHWs per health centers by one unit; which for our model reflected adding 42 VHWs to the nation of Bhutan. This study aims to quantitatively model the impact that VHWs have on health center admissions as well as extrapolate the various cost savings achieved by such health workers. Expenditure of Jigme Dorji Wangchuck National Referral Hospital accounted 17.2 percent of CHE in 2014-15 and 21 percent in 2015-16. More specifically, having access to medications which treat or reduce symptoms of diarrhea, dysentery, or skin infections as well as having VHWs present to sterilize wounds, lead to both decreased risk of progression/infection and discomforts experienced by patients. 2022 BioMed Central Ltd unless otherwise stated.

People with less severe illnesses can be cared for at the new clinics. Health secretary, Dr Ugen Dophu said as people age, Non-Communicable Diseases (NCD) and chronic long-term disease are more likely to occur and so it costs the government more to treat them. We utilized a dataset from the Bhutan Ministry of Health which encompassed over 95% of all reported disease cases within the nation. Prior studies have extensively outlined the cost-effectiveness and cost-saving potential associated with community health workers (CHWs) in a variety of settings [6, 7]. VHWs serve as a source of cost-savings for the Kingdom of Bhutan and also act as an economic buffer for more vulnerable communities. Privacy While the NHA for the fiscal years 2014-15 and 2015-16 is the third such study carried out in the country, it is the first to cover consumer characteristics such as age, sex and illness related patterns in health expenditures. It is possible that a portion of the decrease in admission rates for these diseases is due to VHWs emphasizing preventive measures such as safe working habits and proper food-storage practices. S dollars. Hence, there is not only an economic value of saved wages and incurred cost onto communities, but also a health component in the form of decreased morbidity due to VHWs rapidly providing medications and health resources that may otherwise be difficult to acquire. L.M.A: Aided in study analysis, literature review, and data compilation. Bhutans per capita spending on health was Nu 7,512 during the year 2015 -16, about Nu 500 more than the previous fiscal year, according to the recent National Health Accounts (NHA) study. Project Result / Case Study | 14 July 2022, Project Result / Case Study | 1 July 2022, Project Result / Case Study | 16 May 2022, Project Result / Case Study | 19 April 2022, About ADB, how were organized, transparency, Projects, publications, products and services, operational priorities, and development knowledge, Countries with operations and subregional programs, country planning documents, Careers, business opportunities, and investor relations, Health Sector Development In Bhutan: Improving Disease Detection, Brunei, Indonesia, Malaysia, Philippines East ASEAN Growth Area (BIMP-EAGA), Central Asia Regional Economic Cooperation (CAREC) Program, Indonesia, Malaysia, Thailand Growth Triangle (IMT-GT), South Asia Subregional Economic Cooperation (SASEC), Civil Society/Non-government Organizations, 51141-002: Health Sector Development Program, Download: Together We Deliver - Grants for a Brighter Future, Irrigation Project Cultivates Jobs and Incomes in Ningxia, People's Republic of China, Nepal Earthquake Rehabilitation Builds Back Better Infrastructure, Powering Pakistans Schools through Solar Energy, Upgraded Municipal Services Improve Living Conditions in Townships of Liaoning, People's Republic of China. neonatal care, maternal education, mental health) [8]. 2017;7(2):1264.. Lehmann, U., & Sanders, D. (2007). N.Y: Aided in data collection and analysis. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. These findings translate to 4604 outpatient visits averted, with $28,637 saved, and 78 inpatient visits averted, with $10,711 saved. Springer Nature. 2015;13(1). In both the years, the state has been the principal financier of the health system in Bhutan with a contribution of about 70 percent. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Part of World Health Organization. It will be really helpful to have a good, well-equipped health-care center closer to home.. World Health Organization. To quantify the impact on our dependent variable, admission rates for diseases of interest, we ran multiple multivariate logistic regression models using grouped data for our eight diseases, which VHWs are tasked with handling - either directly or indirectly. Thinley S, Tshering P, Wangmo K, Wangchuk N, Dorji T, Tobgay T, Sharma J. https://doi.org/10.1186/s12888-017-1379-y. In both the financial years, the state spent around Nu 1.6B, the highest on NCD which is about 35 percent of the CHE. It is very likely that VHWs may also decrease health center admission rates for other maladies, most notably diseases such as the common cold and the flu. 1). Retrieved February 12, 2020, from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102009005000016&lng=en&nrm=iso&tlng=en.

Recent reports from the Bhutan Ministry of Health have indicated a sharp reduction in the number of working VHWs. volume20, Articlenumber:1277 (2020) Barnett, M., Gonzalez, A., Miranda, J., Chavira, D., & Lau, A. This is evidently alarming as each VHW lost produces the reciprocal of our findings - an increase of $937 added to the Bhutanese healthcare system and an increase in 111 health center admittances per year. Correspondence to All relevant data remains with the Bhutan Ministry of Health. The model utilized took into account eight maladies which VHWs manage in some form. For a country like Bhutan, Global health experts recommend allocating around 5 percent of the GDP and about 8 percent of the total government budget on health to ensure quality in health care services. While most countries spend more than 8 percent of their GDP on health, he said the government may not be able to give at par with other developing countries. S.C.H: Developed the study idea, collected and analyzed data, wrote manuscript.

Pandemics, of which some of the deadliest have originated in Asia and the Pacific, have to start somewhere. There has been accumulating evidence over the years supporting the continued usage of training for CHWs to address mental health disparities and to improve care for underserved communities.

K.D: Aided in study creation and development. Bhutans spending on health has declined over the years. Manage cookies/Do not sell my data we use in the preference centre. 2011;27(4):288300. The program will build on Bhutans impressive health outcome gains in recent yearsincluding a sharp rise in life expectancy from 43 years in 1985 to 70 in 2017 and a child immunization rate of more than 95% sustained since 2010. The study also found that managing health problems among females were slightly more expensive. This is due to the fact that VHWs are able to provide rapid first-aid and wound sterilization for many non-serious injuries; a common service that VHWs provide and one which is well advertised to Bhutanese communities. The total CHE and expenditure on capital formation borne by the government was about 2.8 and 2.6 percent of the GDP respectively. Five satellite clinics to be built on the outskirts of urban areas and the upgrading of existing primary health care facilities with better equipment will make the country better able to diagnose, treat, and control infections by easing the burden on staff and facilities at the national referral hospital in Thimphu and bringing health care closer to the people. statement and The following disease models predominantly reflect the fact that VHWs are able to rapidly provide simple remedies medications, and treatments to their communities: diarrhea, dysentery, wound care, skin infections. 2017;17(1). BMC Public Health 20, 1277 (2020). Nkonki L, Tugendhaft A, Hofman K. A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes. He lost half of his tuition fees, plus we had to buy a new plane ticket.. Additionally, we found over $800 saved yearly in wages and transportation for every additional VHW added to Bhutan; in which close to 40% arose from transportation cost and the rest from lost wages. Retrieved July 13, 2020, fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557864/. Hauc, S.C., Tshering, D., Feliciano, J. et al.

Integrating community health workers into health care teams to improve equity and quality of care. Google Scholar. However, it is more likely that this decrease arises from community members, particularly those who reside far from health centers, opting to acquire medications from their local VHW rather than from their nearest clinic. Health Policy Plan. The World Health Organizations director of Mental Health and Substance Abuse stated that not only are community mental health services more accessible to people with mental disabilities, but are also more effective compared to treatments typically received at mental hospitals [12]. To assess the fit of our models, we will report McFaddens Pseudo-R2 and perform a Deviance goodness-of-fit to determine the overall fit of our regressions. Globally, CHWs are being used to educate patients on dental hygiene and oral health by connecting individuals to healthcare resources and teaching basic dental hygiene. R version 3.6.1 was utilized in conducting all of the statistical analysis for this study. With regards to dental caries, the decrease in likelihood of visiting a health center likely arose from VHWs efforts to promote dental hygiene. The average unit cost is reported by the Bhutan Ministry of Health as the cost associated for admitting an individual to a health center. All rights reserved, Investing in sports, investment in youth, Exorbitant living standarda threat to the right to life. It further dropped to 3.65 percent in 2010, and to 3.55 percent in 2012. P.R: Aided in data collection and analysis. It already costs us $7 to get there, and the other health clinics are even farther away. Hum Resour Health. It means we are spending less on health., He said the government argues that it gives an annual budget of 6 to 8 percent of the GDP to health sector but that is after including the contributions from the donors. J Community Health. https://doi.org/10.1186/s12960-015-0094-3. Due to this, it is possible that the average cost of admittance at a specific health center is not reflective of the actual cost of admittance for the specific disease modeled. An average one unit increase of VHWs per health center is associated with a decrease in hospital and clinic admission for diarrhea, dysentery, wound care, depression/anxiety, dental caries, and skin infection, while a non-significant increase was observed for scabies and conjunctivitis. This is particularly important as a key barrier to treatment is often access to health centers due to lengthy travel time or structural barriers in commuting [17]. WHO | Nepal. ADB encourages websites and blogs to link to its web pages. The programs medical upgrades will provide sound benefits within Bhutans borders as well. Copyright 2021 kuenselonline. Likewise, transportation costs and wages were modeled using the national average cost associated with transportation to and from health centers and the median Bhutanese salary, respectively. 2015;13(1). Provided by the Springer Nature SharedIt content-sharing initiative. Research has indicated the benefits of VHWs, in terms of both health outcomes and cost-effectiveness, in a variety of economic settings [2]. These figures reveal that VHWs serve as a cost-saving mechanism onto the Bhutanese healthcare system and reduce the number of health center admissions for the diseases modeled. This is especially valuable as our research supports the notion that having CHWs promote dental health can serve as an effective tool in decreasing health center admission rates for tooth decay as well as encourage proper dental hygiene practices. (2010b, December 6). One target is to boost the percentage of people using primary care facilities as their first option from 32% in 2012 to 60% by 2024. While our research does support a clear economic argument for investing in CHWs, the cost-saving figures produced may seem like a small portion of the total Bhutanese healthcare budget. World Health Organization. This was predominately made possible because Bhutan has a nation-wide VHWs program and affords its citizens free universal healthcare; thus, allowing this research to relate health admissions with VHWs impact. https://doi.org/10.1186/s12889-020-09347-4, DOI: https://doi.org/10.1186/s12889-020-09347-4.

Retrieved July 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803443/. This article was originally published inTogether We Deliver, a publication highlighting successful ADB projects across Asia and the Pacific that demonstrated development impacts, best practice, and innovation.

Dr Ugen Dophu said spending on health should not be less than 5 percent of the GDP. The OR estimates, along with the 97.5% CI, for the average impact of a one unit increase in VHWs per health center on health center admissions rates for the eight diseases examined within Bhutan. Matsuzaka CT, Wainberg M, Norcini Pala A, Hoffmann EV, Coimbra BM, Braga RF, et al. In particular for two maladies examined, depression/anxiety and dental caries, there was the most significant drop in the odds of visiting a health center.

Reproductive conditions, which include childbirth and related care consumed 16 and 18 percent of the current expenditure in respective fiscal years. Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care. Our findings consider this metric, while also investigating some of the more unseen factors that may be attributed to VHWs, such as saved wages and transportation costs. The primary reason for this is that the Kingdom of Bhutan holds a surprisingly low cost of admittance to a health center; as low as $2.32 per admittance.

Currently, BHU grade I do not have equipment like X-ray, ultrasound and dental chair because of lack of fund, he said. Appropriate requests can be made at: info@health.gov.bt. Immunization coverage in Bhutan is maintained over 95%, while neonatal tetanus, leprosy, iodine deficiency disorders, and malaria have been largely eliminated. PubMedGoogle Scholar. As such, the economic argument for investing into Bhutans CHWs is evident as our research has delineated the program as a cost saving initiative.

The Cost of Healthcare Services in Bhutan. He went back to the national referral hospital afterwards, says his mother.

Bhutan received $13.3 million from the $52.8 million grant facility set aside under Asian Development Fund (ADF) 12 for projects and programs related to regional health security because its health information management systems need improvement and its technology and data standards vary widely. It is also upgrading the countrys disease surveillance systems and policies to help Bhutan and the region prepare for and manage pandemics. The expansion and upgrades of primary care facilities under the ADF program will ease the current pressure on the hospital and the frequent delays in diagnosis and treatment, says Gosa Pemba, its 57-year-old medical superintendent. All funding was made possible by the Bhutan Ministry of Health. By using this website, you agree to our Detecting and treating disease near the source and early on can swiftly curtail the potential spread and growth of human suffering and economic loss across a country, a region, and sometimes the entire world.

For the fiscal year 2014-15, the spending on health was 4, which dropped to 3.9 percent of the GDP in 2015-16. Less than five is not good for the people of Bhutan. Similarly, the lost wages and transportation costs also incur proportionally to our findings. We then further stratified for the number of admissions and associated costs that were outpatient vs. inpatient. But per capita spending on health has increased. Administrative permissions are necessary to obtain the respective data through the Bhutan Ministry of Health. BMC Public Health The unique structure of this research allowed us to quantitatively measure the impact that VHWs have on expanding access to health resources and their associated economic impact by using health center admissions as a proxy. ADB worked with Nepal following the 7.8 magnitude earthquake on 25 April 2015 and the devastating aftershock on 12 May 2015 that cost 9,000 lives and destroyed thousands of structures in Kathmandu and nearby towns. Lastly, we utilized the 2011 A Costing of Healthcare Services in Bhutan to estimate the cost saved attributed to VHWs. The Kingdom of Bhutan is a small land-locked country situated in between the Indo-China Himalayan border. Such data did not contain any personal identifiers and had been previously collected for purposes external to our investigation. In Bhutan alone, there has been a~20% decrease in VHWs since 1992 [1].

However, for many rural and impoverished communities the only available source of emotional and psychological support may come from these health workers. A.M.P.A: Aided in study analysis, literature review, and data compilation. Costs and cost-effectiveness of community health workers: Evidence from a literature review. He was declared clear of tuberculosis, says the 56-year-old mother of six from the capital city, Thimphu. Retrieved from https://www.who.int/hrh/documents/community_health_workers.pdf.. Cook, S., & Keesecker, N. (2015). More specifically, the OR for each model was multiplied by the annual number of admissions for each disease; this revealed the number of averted cases. More than 12,000 public schools in Pakistan are now enjoying reliable electricity thanks to solar power, dramatically improving the learning environment for over 1.4 million students. It is for this reason, that we believe that the figures provided represent a minimum of cost savings and number of averted cases.

WHO | India. Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. These are notable components to consider as the work VHWs provide proves to be a substantial factor in avoiding lost wages and incurred cost in low-resource communities.

(2018, March). Vaughan K, Kok MC, Witter S, Dieleman M. Costs and cost-effectiveness of community health workers: evidence from a literature review. Hum Resour Health. Ethics approval was provided by Human Research Protection Program Institutional Review Board at Yale University and the Bhutan Research Ethics Board of Health.

Additionally, we estimated a yearly savings of $13,348 in transportation costs and a total of $20,960 saved in wages to the community members that VHWs serve. If the spending, excluding the donors, is at least five percent of the GDB, then we will have more money to spend on health.. Bhutans health promotion efforts are largely overseen by the Ministry of Health, while health services are delivered via a three-tiered system: Basic Health Units I and II (BHUs) at the primary level, district hospitals at the secondary level, and the national and referral hospitals at the tertiary level. Its frustrating when your child is sick and getting worse and he cant receive the proper care. The family paid to use a private clinic. That will give doctors here more time to do and complete quality work., The new satellite clinics will be closer, easier, and cheaper to visit than the national hospital for many, including the poor.