A milestone in Bhutan’s health sector was the establishment of the Bhutan Health Trust Fund (BHTF), which was officially launched on May 12, 1998, at the World Health Organization (WHO) headquarters in Geneva with an initial target of USD 24 million. A Royal Charter from His Majesty the Fourth Druk Gyalpo in 2000 formally established the Trust with fund capitalization to be done through contributions from donors and the royal government on a one-to-one partnership.
The fund became operational in June 2002, initially financing only a small portion of essential drugs and vaccines. However, BHTF has come a long way especially in ensuring sustainability of the count ry’s free health care system, and fulfilling the constitutional mandate of providing free primary health care services to all people. As of June 30, 2022, BHTF spent a total of Nu 416,884,337.56 on purchasing essential of medicine and drugs and had total fund of 3,800,035,079.64. The highest donation was received in the fiscal year 2017-2018, which amounted to Nu 511 million, followed by Nu 19 million in the year 2016-17.
Since 2015 Bhutan Health Trust Fund (BHTF) has been fully financing the procurement of essential drugs. As of 2021, BHTF had spend more than USD 25 million on essential drugs.
In its support towards the procurement of essential drugs and vaccines for the public health system in the country, BHTF in the fiscal year 2021-2022, released a total of Nu 416.82 million. From this amount, a total of Nu 110 million was released to Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Nu 258.92 million to Department of Medical and Supplies and Health Infrastructure (DMSHI), and Nu 47.964 million to Vaccine Preventable Diseases Program (VPDP), Department of Public Health (DoPH). BHTF has also released an amount of Ngultrum (Nu) 150 million to the Department of Medical Supplies and Health Infrastructure (DMSHI) for the funding of the procurement of essential drugs for the first and second quarter of the financial year 2022-2023.
The BHTF also helps introducing new vaccines and expanding immunization coverage in the country. Through the fund, the first pneumococcal conjugate vaccine (PCV 13) was introduced in 2019 at the cost of Nu 9.2 million annually. The fund also helps in vaccinating girls with human papillomavirus (HPV) vaccine. In 2020, about 5,992 girls were vaccinated with the first dose of HPV vaccine.
The interim director of BHTF said that the whole of Bhutan benefits from the fund as they get free vaccines and medicines from hospitals. He added that annually on average Nu 420 million is released for purchase.
BHTF receives its income from interest from fixed deposits, health contributions from individuals and organizations, and grants and donations from national and international sources. The BHTF also manages the fund on behalf of the Asian Development Bank (ADB), which granted USD 10 million to the BHTF in the biennial year 2018-2020.
According to the report of 2019-2020, the government continues to be the biggest donor to the BHTF, amounting to USD 19,038,182, followed by ADB with USD 5 million. Other international foundations such as Government of Norway, Bill and Melinda Gates Foundation, Summit Foundation, Dr. Fredrick Paulsen Foundation, and GAVI also contributed to the fund.
Interest received from investment in fixed deposits, deposit in saving account, bonds and annuity schemes in local financial institutions, investment in the off-shore market in fixed deposit, and 1% health contribution collected from a working group of Bhutan are the major source of funds. The funds collected in forms of accrued interest and health contributions are utilized to finance the procurement of essential drugs and vaccines in Bhutan. The BHTF aims to ensure that every Bhutanese has access to quality health care services without any financial hardship.
Meanwhile, a landmark in the history of BHTF was the “Move for Health Walk,” led by the former minister of health and education, Lyonpo Sangay Ngedup. On the morning of 25th September 2002, the walk was flagged off from Trashigang. The team stopped at villages, Basic Health Units (BHUs) and Schools to talk and spread the message about healthy lifestyles. After a grueling 16 days, the team concluded the epic journey on October 10th, 2002 as they entered the historic Changlimithang ground. The walk created awareness and revived the initial capitalization of BHTF. Government organizations, international agencies, the diplomatic community, individuals, business houses, families and NGOS contributed to the health trust fund with the walk raising close to USD 2 million for the Bhutan Health Trust Fund.
Nidup Lhamo from Thimphu