RESUMEN
Bhutan, a landlocked country in the eastern Himalayas with some of the most rugged and mountainousterrain in the world, is actively engaged in digital health strategy reforms aimed at improving theefficiency of the health information system. Aligned with Bhutan’s e-Government master plan, theNational eHealth strategy and action plan aims to improve health by empowering health-care providersand citizens through technology and by enabling data exchange for service delivery. The strategy hasfour primary areas of focus: (i) ensuring digital health governance arrangements; (ii) concentratingon strong foundations in terms of infrastructure and standards; (iii) prioritizing improvements in thecurrent health system in a phased, selective manner; and (iv) building the digital skills and knowledgeof health workers. With support from the Asian Development Bank and the World Health Organization,phase 1 of the strategy has been completed and the blueprint for the digital health information systemis in development. Phase 2 of the strategy will be implemented during 2020–2023 and will include workon (i) identity management for the health workforce; (ii) the implementation of a master patient indexand a secure longitudinal patient information system; and (iii) enabling all health facilities to access thesystems. Bhutan’s eHealth strategy has the potential to fundamentally transform the delivery of healthservices, strengthen primary health care and enable the development of a “One Health” public healthsurveillance system.
Asunto(s)
Sistemas de Información en SaludRESUMEN
Background Despite Bhutan’s remarkable progress in the area of maternal and child health duringthe era of the Millennium Development Goals, a large proportion of pregnant women are still deliveringat home with no skilled attendant. Limited empirical studies have been carried out to understand thefactors associated with delivery at home in Bhutan.Methods This cross-sectional analytical study used secondary data collected in the nationallyrepresentative National Health Survey 2012. The survey included a total of 2213 women aged15–49 years who had a live birth in the 2 years preceding the survey and were selected usingmultistage stratified cluster sampling. Weighted analysis was done to evaluate determinants for theplace of delivery. Unadjusted and adjusted prevalence ratios with 95% confidence intervals (CIs) werecalculated to assess the possible association of factors with home delivery.Results Out of 2213 women aged 15–49 years who had a live birth in the 2 years preceding thesurvey, 73.7% had an institutional delivery. Coverage of institutional delivery ranged from 49.4% inZhemgang district to 96.1% in Paro district. Women in the poorest wealth quintile were 7.35 timesmore likely to have a birth at home compared to women in the richest quintile (adjusted prevalenceratio [aPR]: 7.35, 95% CI: 2.59–20.9). The older mothers aged 30–49 years were 0.79 times(aPR: 0.79, 95% CI: 0.70–0.88) less likely to have a home delivery than mothers aged 15–19 years.Women who had fewer than four antenatal care visits were 1.50 times (aPR: 1.50, 95% CI: 1.35–1.66)more likely to give birth at home compared to those who had four or more visits. The mothers givingbirth for a third or more time were 1.88 times (aPR: 1.88, 95% CI: 1.60–2.22) more likely to give birthat home compared to those giving birth for the first time. Women living in rural areas were 2.87 times(aPR: 2.87, 95% CI: 1.42–5.77) more likely to deliver at home compared to those living in urban areasand women living in the eastern region of the country were 1.35 times (aPR: 1.35, 95% CI: 1.17–1.55)more likely to have a home delivery compared to those living in the western region.Conclusion Lower socioeconomic status, rural location, eastern location, non-first birth, and havingfewer than four antenatal visits were significant factors associated with home delivery. These findingsshould inform further research and policy to build on Bhutan’s progress in promoting institutionaldelivery as the key strategy towards improving maternal and child health and achieving the relevanttargets of Sustainable Development Goal 3.