Tshering Yangden
National Referrals Hospital, Bhutan
Title: Improve the quality of reproductive life of men, women and adolescents providing quality reproductive health services within the framework of national goal of GNH
Biography
Biography: Tshering Yangden
Abstract
Demography: Bhutan’s population was 672,425 in 2005 with women of reproductive age group (15-49 years) about 160000 with about 12500 live births per year (PHCB 2005). TFR has dropped from 5.6 in 1994 to 2.3 in 2012 (NHS 2012).
Major RMNH Components: Safe motherhood includes EmONC, P&M of complicated abortions and family planning P&M of infertility. Reproductive tract infections include HIV, screening and prevention of cervical and breast cancer, newborn care, adolescents’ health-teenage pregnancy reporting mechanism.
Issues/Challenges/Concerns: Disparity in the algorithm of maternal and child care–ANC, delivery, PNC, immunization, IMR and U-MR is two to three times higher in the poor quintile compared to the richest. Maternal deaths occur mostly in far flung areas. Home deliveries still take place predominantly in the rural settings. Recording and investigating deaths following home delivery remains a major challenge (under reporting, unrecorded). Emphasis/compliance of birth plans preparation by pregnant women still remains weak (draft institutional delivery study, 2016). Tracking of pregnant women and especially high-risk pregnancies is a challenge. PNC coverage and access in rural settings remain relatively lower as compared to other settings. Pap smear coverage is low for want of female health workers–environment, advocacy, among other reasons. Increasing number of CS is not need-based. Growing number of women seeks abortions in neighboring India. Use of family planning methods is concentrated on a few methods (supplies).
Way Forward: Web-based MCH tracking system would be major breakthrough to address spectra of maternal and child care–computers, internet connectivity, and nothing short of commitment by users! Healthcare providers should ensure every woman has a comprehensive birth plan in the health center. Training of healthcare providers on PPH–guideline being revised focusing on prevention and management. Training Packages are on KMC, neonatal resuscitation and ENAP! Underscoring our priorities, challenges and opportunities, let us work hard, invest our energy, time and resources channeling through right course, right direction towards right goals! But working together in the spirit of relentless coordination, consultation and collaboration on the international platform would be great help to the under developing countries like Bhutan.