The Ministry of Health has come up with a National Health Promotion Strategic Plan (NHSP) 2013 – 2023 that all major government ministries and agencies allocate at least one percent of their annual budget for health promotion activities related to the respective agencies.
This is because under the plan the 10 ministries and other relevant stakeholders are required to mainstream health promotion plans and activities into sector plans.
The plan says that there is evidence that there is still an overemphasis on information and communication interventions which has improved knowledge levels but has not been as effective in addressing the broader determinants of health.
Hence the plan says a significant change in direction is needed within the health system to address health in a holistic manner emphasizing on a multi-sectoral, multi level and multi strategic approach.
Identifying the problems the report says that Health continues to collaborate, for the most part, on the same traditional sectors such as education, agriculture, Ministry of Information and Communication and does not adequately engage other sectors. It says priority for resource allocation remains in ‘curative care domain’, there is lacks holistic approach in addressing determinants of health and health impact assessment is not included in the GNHC screening tool.
The strategy apart of mainstreaming health into all agencies and ensuring better coordination between agencies will facilitate equity through healthy public policies, enabling supportive environments to live, work, study and play, improving access to health services.
The strategy will ensure that resources allocated for health promotion will result in a healthier and socially vibrant community.
It will develop and strengthen the capacity of Ministry of Health to address the major determinants of health through a health promotion approach.
The NHSP is based on the five key strategic areas of Health in All Policies (HiAPs), Capacity Building, Healthy Settings, Targeted Interventions for Priority Health Concerns and Innovation for Sustainability.
To improve and foster the ownership of the interventions at all levels, the document highlights the key roles and responsibilities of all the stakeholders with Health Promotion Division (HPD) as the nodal agency at the national level to coordinate and initiate partnership building among different sectors.
For better monitoring the National Health Promotion Steering Committee (NHPSC) is proposed to oversee the monitoring and evaluation of the NHPSP. The proposed members for National Health Promotion Steering Committee (NHPSC) are the Gross National Happiness Commission, Ministry of Economic Affairs (MoEA), Ministry of Education (MoE), Ministry of Agriculture and Forestry (MoAF), Ministry of Works and Human Settlement (MoWHS) (Thromde/Urban Planning), Ministry of Labor and Human Resources (MoLHR), Bhutan Chamber of Commerce and Industries (BCCI), Civil Society Organization (CSO), Media, Religious Body, Bhutan Olympic Committee and the Ministry of Health (MoH).
The integrated and collaborated efforts of multi-sector approach takes into account the wider socioeconomic, cultural and environmental conditions which impact on health and happiness of our society.
The collective efforts of multi-sectors are targeted towards improved maternal and child health, nutrition, water and sanitation, health of school children and adolescents, improvements in health of elderly and reductions in non-communicable and communicable diseases.
As per the plan the government will endorse health promotion as a priority at the highest level and commit to support the NHPSP, allocate adequate funds, ensure effectively implementation by respective sectors, promote NHSP, support Health Impact Assessment as a requirement for all development projects and Endorse formation of National NHPSC.
The document also lays down the roles of various agencies.
The GNHC will enforce GNH screening tool to screen all government policies to ensure HiAP, support its implementation and enforce Health Impact Assessment as a requirement for all projects.
Local governments will mainstream health promotion plans and activities into sector plans, support implementation local level health promotion initiatives, support enforcement of laws and regulations particularly related to harmful use of alcohol, tobacco use and road safety, promote community ownership of Water and Sanitation infrastructure and support and the role of trained village health workers.
The MoEA will implement economic interventions targeted to reduce harmful use of alcohol (example licensing to regulate availability of alcohol and tobacco), support initiatives to promote social responsibility for health in the corporate sector and initiate alternative source of energy.
The Ministry of Finance will Mainstream allocate adequate funds, enforce sales tax, customs or excise taxes related to alcohol, tobacco, and other harmful substances and products, support introduction of economic measures such as taxes on junk foods and allocate adequate funds for building and maintaining water and sanitation infrastructure as a public health foundation.
Dratshang Lhentshog, Choedhey and Religious bodies will improve awareness of religious leaders about NCD prevention measures, sanitation and hygiene, harmful effects of tobacco and alcohol use, and nutrition for children and adolescent girls.
MoE will incorporate into curriculum content and skills required promoting healthy behaviors such as good nutrition, regular physical activity, responsible sexual behavior, personal hygiene, etc. It will also strengthen health literacy into non-formal education curriculum and ensure safe and healthy environment in school, and removing health hazards within and around the school, including selling of alcohol, cigarettes, tobacco products, etc.
The MoAF will undertake measures to regulate and enforce food safety and quality and formulate and implement policies that increase availability of affordable and nutritious foods, particularly to rural populations.
The BCCI will take actions that will increase accessibility to healthy and nutritious foods, promote healthy work places, reduce harmful use of alcohol, and reduce tobacco use.
The RCSC will promote healthy working conditions for civil servants.
The MoLHR will enforce occupational health and safety policy to ensure workers’ health.
The MoWHS will engage in the sensitization of urban planners, engineers, architects and designers on the need for health promoting built environments.
The RSTA will develop and implement policies that prevent drink driving, and promote road safety, make changes to roads that will promote safety of pedestrians and enforce regulations that promote safe driving and safety on roads for pedestrians.
The NEC will monitor water and air quality and regulate waste management.
CSO’s will Partner with schools, health institutes and local government to promote health, particularly promoting well-being of elderly and youth and engage in advocacy for health promoting policies.
International agencies like WHO, FAO, UNICEF, UNESCO, ADB and UNFPA have also been assigned roles in line with their functions and mandates.