SCCI has reached 14 district as of now, while four are in the pipeline
Beginning 2018, people in four districts of the country, Zhemgang, Tsirang, Punakha and Wangduephodrang, could access health facilities without worrying about the expenses incurred, for transportation and others. They could get vital drugs at their convenience. Patients no longer needed to travel to a district or regional hospital to get some of their medication.
This happened after Bhutan’s health system adopted and launched the Service with Care and Compassion Initiative (SCCI) in four dzongkhags (districts) in 2018. However, it has now been expanded to cover all districts in the country.
SCCI is Bhutan’s adaptation of the World Health Organization’s (WHO) Package of essential non-communicable (PEN) Technical Package. Under this program, whenever a person visits a health centre for any reason, in addition to receiving medical care, they are also screened for a host of noncommunicable diseases (NCDs) and risk factors such as blood pressure and sugar levels. If found to be hypertensive, diabetic, or having risk factors for NCDs, the person is immediately put on a treatment plan.
Further, under SCCI a new prescription system was developed enabling health assistants in local primary health Centers to request all levels of hospitals to deliver medication for patients. SCCI also reduced crowding at hospitals, and the program’s success is due to handholding primary health centers by larger hospitals to sustain the initiative in districts.
According to the official website of WHO Bhutan Country office, although SCCI has made a difference in the delivery of NCD care to people, several challenges and issues have arisen in its effective implementation, including streamlining vertical reporting of data, resource mobilization, and integration into the primary healthcare approach. Bhutan’s effort to integrate SCCI into the primary healthcare approach and include it as part of university curricula will ensure its long-term sustainability.
Meanwhile, Pema Lethro, National Professional officer of WHO Bhutan said, SCCI initiatives have covered 14 districts, while four are in the pipeline.
“Sarpang, Haa, Paro, Chukha, Samtse and Thimphu are the districts that are yet to get the initiatives.”
He also added that they have used various approaches to cover and provide the service to the unreached villages.
“For instance, we have used a ‘Mentor-Mentee’ approach in Punakha and Gasa dzongkhags. While Punakha is a mentor district, Gasa is a Mentee, who receives the facilities from the mentor district. And similarly, for the bigger dzongkhags, we have a different approach.”
One of the reasons for the success of SCCI is the guidance provided by larger hospitals to primary health centers (PHCs) to maintain SCCI in districts. A team led by a doctor provides mentorship and leadership to two PHCs, and any challenges faced by the PHCs are addressed at least every six months. This support ensures the sustainability of SCCI and contributes to its effectiveness.
He said that there is at least one NCD focal person in each district to monitor the situation.
“One of the most beneficial features of SCCI is that patients can now obtain essential medications at their convenience, which has been life changing for some individuals,” said Pema Lethro, adding that patients not only receive medical care but are also screened for various non-communicable diseases (NCDs) and risk factors, including monitoring of their blood pressure and sugar levels. If a patient is diagnosed with hypertension, diabetes, or found to be at risk for NCDs, they are immediately prescribed a treatment plan.
Meanwhile, he said that NCD accounts for two-thirds of all deaths in the WHO South-East Asia Region, making prevention and control of NCDs a priority in the region. Member countries have been making concerted efforts to combat NCDs, including scaling up NCD services at primary health care level, promoting physical activity, taxing sugary drinks, and controlling tobacco and alcohol use.
Zhemgang was one of the four pilot dzongkhags under SCCI. Leki Legyel, the NCD focal person at Zhemgang Hospital, earlier said that his patients are extremely happy about the program. One aspect of SCCI is opportunistic screening, which happens when a patient comes to a health centre for any illness. The patient is not only treated for that illness, but also screened for a host of NCD risk factors such as sugar levels and blood pressure. Leki had said that within his catchment area alone, they have detected 44 diabetes cases and 170 hypertension cases. Those with mild NCDs are recommended dietary and lifestyle changes, while others are put on medication.
According to Leki, another aspect of SCCI that Zhemgangpas particularly find helpful is home-based care for homebound patients. These patients cannot come to their health centres for a variety of reasons. For them, health workers provide care at their doorstep.
The SCCI initiatives has not only benefitted the people in detecting NCD and getting the needed medication and treatment but also reduced crowding at the hospitals.
‘People like that they were now checked for everything – blood pressure, body mass index (BMI), alcohol and tobacco use, and cardiovascular risk. The program has reduced crowding at our hospital too,” said Dr Sangay Dorji from Wangduephodrang hospital.
According to an earlier article by WHO, Bhutan, while SCCI has made a difference in the delivery of NCD care to people several challenges, gaps and issues have arisen in its effective implementation. These include standardizing and designating kits for health workers visiting home-care patients, streamlining vertical reporting of data, building capacity and a virtual learning environment, resource mobilization and integration into the primary healthcare approach.
Efforts to integrate SCCI into the primary healthcare approach and include it as part of university curricula to ensure its long-term sustainability will also be vital to ensure SCCI continues to make a tangible difference in the delivery of NCDs care to people and communities and in the battle against NCDs.
Tshering Pelden from Thimphu