1. NON-COMMUNICABLE DISEASES IN BHUTAN
TANDIN DORJI
CHIEF
NON-COMMUNICBLE DISEASES DIVISION
DEPARTMENT OF PUBLIC HEALTH
MINISTRY OF HEALTH

2. Country Profile Area: 38,394 Km2 Population: 0.74 mill. (current)
Life Expectancy: 68.9 (2005)
IMR: 60.5/1000LB (2000)
MMR: 255/100,000 LB (2000)

3. Alcohol Liver Diseases Disease incidence per 10,000 population
NCD Situation
Disease incidence
Year
2007
2008
2009
2010
2011
Alcohol Liver Diseases 22 20 23 28 29
Cancer 13 10 17 15 14
Diabetes 26 38 47 53
Hypertension
294
303
310
343
325
Disease incidence per 10,000 population

4. Multi-Sectoral Intervention
Tobacco Control Act 2010
- Ban on Sale of Tobacco products
- No smoking in public places
- Numerous stakeholders

5. Introduction of PEN
Adoption of WHO proposed Package of Essential NCD (PEN) interventions
Piloted in 2 districts in 2009 for 6 months
Reviewed in 2011
Early detection and management of individuals having higher level of risk factors for NCDs, to reduce NCD disease burden and complications, improving the survival and quality of life

6. PEN contd.
All NCD patients attending OPDs in the health institutions registered.
All patients >40 years
counseled for smoking cessation, alcohol harm reduction, healthy diet and physical activity
screened for high BP and overweight/obesity; those having over-weight/obesity tested for blood sugar
registered if found to have hypertension or glucose intolerance or diabetes
A clinical record form was used for registration & follow-up; it was kept in a folder or registers

7. PEN Review 2011 PEN intervention successfully implemented
PEN protocols user friendly; most of the health workers could follow
Capacity of health workers (knowledge and skills) enhanced
Community awareness on major NCD risk factors increased
Glucometers and peakflow meters supplied to the health facilities

8. Successes and Challenges
Awareness on NCDs
Adoption of PEN in all health centres
National Policy and strategy
Challenges
Enabling environment
Double burden of disease
Information
Resource constraints

9. THANK YOU