The Bhutanese Leading the way.
Although the People Centered Care-PEN HEARTS project PEN was initiated before, however, it was never implemented. Ministry of Health with a support from WHO has now initiated the pilot project in two dzongkhags this year. The main objective of the project is to control, diagnose and prevent Non-Communicable Diseases (NCDs) at an early age.
The pilot project is on the roll in Punakha from May 2019 and Tsirang in June 2019. There are 7 BHU IIs, 1 health sub-post and one district hospital in Punakha and Tsirang combined.
The officiating District Health Officer (DHO) of Punakha, Namgay Dawa, said with the improvised People Centered Care-PEN HEARTS project, both the patients and health workers can take the opportunity in looking out for other communicable diseases when they are providing services for NCDs to the patients.
In the past, as set in PEN protocol, health workers do the screening of the patients who are above the age of 40 years in the health centers, he said, adding that the age was set at that range since they are prone and risk to NCDs.
He said, “If any of the patients are detected with any diseases, like hypertension or diabetes, they will then be treated after a thorough investigation. However, they were not strict on follow-up part, whereby the health workers were not concerned if the patients come for follow-up or not.”
Today, there is a change, he added. He said that since the project is people centered care services they do not go into the community or in any of the institutes. Instead the health workers will stay in hospital or BHU to facilitate whoever comes to get the services.
“Today, whoever (age 20 and above) comes to avail the health services, they will be screened thoroughly. We provide various services. We have a triage corner, whereby the height and weight of the patients will be measured to find out Body Mass Index (BMI), their BP and blood sugar will be examined, they will do lipid profiling and they will do auditing of alcohol and tobacco to see if they are at risk,” he added.
He also said high risk patients are given the necessary attention and tests, such as the vision, renal, liver and kidney tests. Those at lower risk category are given counseling.
“If a person is suspected diabetes from BHU then they get help of the district hospital for confirmation. We have a service called sample shipment, whereby we call the lab technician to the BHUs with an appointment to collect the sample. If needed we also mobilize doctor, whereby the patient need not have to travel to hospital spending lot,” he added.
They dispatch the report through different means of IT facilities so that the patient or the health worker need not have to travel just for the sake of the report.
However, he said that they give patients a choice, those who are stable economically and they wish to travel to district hospital then they allow them to do so. Otherwise, they provide every facility in the BHUs, he said.
He said, “We also provide palliative care to those patients who are bed ridden, cancer patients, disabled and visually impaired. Health workers will travel to their house from time-to-time to provide the health services.”
Moreover, he said that they now follow-up the case strictly. If a person fails to turn up on time then they call and ask the patient to come for a follow-up. Patients are encouraged to check their health status every after six months, he added.
Meanwhile, Senior DHO of Tsirang, Lobzang Tshering, said, “In 2013, Bhutan referred 314 patients outside the country for treatment. So, if the patients are diagnosed at an early stage then there will be positive impact on country’s economy and lots of resources can be saved. So if that cost is saved and diverted to the developmental activities then a lot can be done.”
He also said that many patients are failing in continuity of taking drugs for NCDs, BP and diabetics, in particular, because those need to be brought from the hospital, as BHUs are not entitled for the said drugs.
“We send health workers to district hospital to get the required drugs with the details of the patient and disease,” he added.
It was found that many people do not pay much attention to the medical screening campaign and awareness on public health. Lobzang Tshering said people should attend such health screening to find out about their health status, and not to cause any economy burden on the family and country.
The pilot projects have received positive feedback from the people. The government is looking forward to setting the initiative in other district as well.
