Map of Bhutan

1. Map of Bhutan

2. Different regions West W Central C East south south

3. HEALTH EQUITY ANALYSIS OF BHUTAN Household level Household member level Pregnancy and live birth level

4. Data collection questionnaires Schedule A: village folder SCHEDULE A: VILLAGE FOLDER Dzongkhag….……….………………….. G1 Geog Code.……..… [][ ][ ][ ] V1 Size.……....….…… [][ ][ ][ ] V2 sample village code......... [ ][ ]

10. 1.Household level • Sanitation (latrine) coverage • Access to safe water • Illness within the past one month

11. * Blown to 100,328 nationally

13. Latrine coverage in rural areas.

15. 2. Household member level • Modern contraceptive use • Antenatal care • Delivery care by trained health personnel • Delivery at the health facilities

17. Contraceptive method used by married women • Almost 30.7% of the reproductive age women who were married and not known pregnant during the survey chose to use the modern methods of contraception • These include sterilization, pill, DMPA, Vasectomy, IUD, and condom.

18. Contraceptive methods practiced by the married women

19. Method of contraception

20. Antenatal care • The total number of women who had ANC at any gestation periods was found to be 51%; • However, this should not be directly interpreted as the proportion of the reach of antenatal services to pregnant women. This is so as women in earlier trimesters either do not yet realize that they are pregnant or that they may wait for the pregnancy to advance a little before they decide to seek ANC. • The analysis should tie the time of ANC to the period of gestation; hence it was divided into following three groups: 1-st, 2-nd, 3-rd trimesters (as the denominator)

22. Delivery care by trained health personnel and at health facility • The number of women who took delivery care from trained health personnel in 1996 was found to be 19.6% which increased to 27% in the year 2000 , even though it shows some increase, it is still a long way off from the target of all births to be attended by trained attendants. • The number of women who took delivery at health facilities in 1996 was found to be 15.1% which increased to 23% in the year 2000, even though it shows some increase, it is still a long way off from the target of all births to be delivered at the health facilities.

23. By the latest year 2000

24. 3. Pregnancy level • Teenage pregnancy • Breast feeding • Under-five mortality • Infant mortality • Place of death of children • Want more children?

25. Appendix Table 1 Number of households and household members sampled Women 15-49 years who gave live births (Pregnancy level data) * Blown from 16,197 samples, included only non-missing data

28. By the latest year 2000

29. Teenage pregnancyMultivariable analysis

30. Under-five mortality Multivariable analysis

31. Infant mortality Multivariable analysis

32. Income Distribution by Country

33. Recommendation • The existing 2000 National Health Survey report has given an illustration on the overall status of the population health. • This report added new information on the differential characteristics of household status with respect to health conditions, woman and child health across geographic locations and socio-demographic stratifiers. • It is useful as a tool for monitoring and evaluation of health (in) equity of the people of Bhutan over times. It sheds light on the target group of population whom the health policy should pay specific attention to. • For example, the eastern region was found worse than the others in usage of contraceptive by married women (28.2%), delivery care by trained health personnel (13.8%), delivery at the health facilities (8.0%), under-five mortality (12.7%), and infant mortality (12.6%). This is to reduce the gap in the area identified as health inequity priority.

34. Recommendation • One woman health issue that this analysis did not touch upon despite the available data (Schedule G) is maternal mortality. Since the mortality folder cannot be linked individually to the past pregnancy folder which contain individual live births and the corresponding event years, the denominator (i.e., number of live births) of the maternal mortality ratio cannot be determined.

35. Recommendation • Unfortunately, the analysis cannot deal with economic disparity issue since there were no quests on the economic status of the surveyed households. The economic well-being can be captured using the questions on regular consumption expenditures, asset belonging and properties, and (in-cash and in-kind) incomes. Hence, this report recommends the next health survey incorporates the economic-based questionnaire items.

36. Recommendation • The National Health Survey questionnaire for health seeking behavior has only the out-patient queries by days of illness and the two sources of care. It will be more useful if the frequency of visits for each particular type of care and the amount of household direct payment are also recorded. • The queries on in-patient care will be a useful complement if they are also included in the survey. The inpatient questions should include (1) frequency of admissions, (2) days of stay, and (3) payment made by the households for services and traveling costs. To allow for the relatively uncommon events, a recall period of 12 months should be used for the inpatient questions. • With these types of health service utilization data, a further analysis on the equity in health utilization and public subsidy, so-called ‘benefit incidence analysis’ (i.e., whether the health resources are pro-rich or pro-poor) can be performed.

37. SCHEDULE F: HEALTH CARE SEEKING BEHAVOUR FOLDER Dzongkhag….…….…………..…………….. G1 Geog Code.………….. [][ ][ ][ ] V1 Size…….……….…… [][ ][ ][ ] V2 sample village code................ [ ][ ] HH1 Household Sr. No….……… [ ][ ][ ] HM1 Sr. No. of individual ……………..... [] Please specify other (if any) for HS3, HS4 and HS5 in the space below also give the specific HM1 code.

38. ~~~~~~~~~~~~~~~~~~Thank you very much, for your kind attention and time.~~~~~~~~~~~~~~~~~~