Diabetes is a significant problem for Bhutan’s health system. Despite making rapid progress in reducing premature death from noncommunicable diseases such as cancer, heart and respiratory diseases, Bhutan has witnessed a rising trend of diabetes over the past four decades. This increase is attributed to a rise in risk factors such as overweight, high blood pressure, and worsening unhealthy diet and sedentary behaviours.
Just as it has made progress for other NCDs, the Royal Government of Bhutan is being proactive on diabetes. In 1996, it established its first National Diabetes Control Programme, setting up diabetes clinics in all 20 district hospitals across the country. This programme has since been updated, adding health promotion, screening, treatment and referrals, while recent research identifies ways to optimize these clinics, improve glycaemic control and ensure people who need support keep coming back.
More recently, Bhutan was one of the first countries to pilot and scale up WHO’s “Package of Essential Noncommunicable” (PEN) disease interventions in primary health care settings, and has also developed a bespoke strategy to prevent and control NCDs. Currently, 46 health settings have adopted person-centred PEN tools, with these settings now mentoring to other clinics in how to adopt NCD care across the country.
Insulin: a life-saving medicine out of reach for too many
Insulin was first discovered as a treatment for diabetes 100 years ago. A hormone created by the pancreas to control the amount of glucose in our blood streams, insulin has been on WHO’s Essential Medicines List ever since first being published in 1977.
All people with type 1 diabetes need insulin to survive. And globally, only around half of the 60 million people with type 2 diabetes can access the insulin they need.
Cost is an issue. Insulin prices are currently a barrier to treatment, both in Bhutan and elsewhere. Three manufacturers control most of the global market for insulin, setting prices that are prohibitive for too many.
Other initiatives to increase availability of insulin
Ensuring everyone who needs insulin can get it is an ongoing challenge.
One activity that offers hope for the future is the potential for prequalification of insulin by WHO. Prequalification of insulin produced by different manufacturers could help increase the availability of quality-assured insulin to countries which are currently unable to meet demand. WHO will also continue to engage in efforts to boost access to insulin in humanitarian settings.
For Dr Rui Paulo de Jesus, Head of WHO’s Country Office in Bhutan, sustainable insulin is an important factor in helping people with diabetes across the country:
“Improving Bhutan’s access to insulin has enabled people across our country to avoid costly complications from diabetes. While it is only one piece of the puzzle, the sooner that insulin can be reliably and equitably accessed by all who need it, the better. At the same time, I would like to urge all Bhutanese to live a healthy lifestyle.
Caption: Dr Rui Paulo de Jesus hands over insulin plans to former secretary, Dr. Ugen Dophu, Ministry of Health. Credit: WHO Country Office for Bhutan.
Bhutan recently benefitted from a temporary donation by one of these companies, Novo Nordisk, as part of a contribution to 50 lower- and middle-income countries in 2020. Specifically, Bhutan received 13 000 vials of three different types of insulin. Also donated were 100 doses of glucagon, a medication used to treat low blood sugar levels.
These 13 000 vials of insulin reached 48 district and regional hospitals across the country. Insulin was made available to people with both type 1 and type 2 diabetes. As Dr Pandup Tshering, Secretary of the Ministry of Health of Bhutan describes, benefitting from insulin has benefitted people with diabetes across the country:
“Insulin helps people across Bhutan to control their diabetes. The donation has allowed us to replenish our stocks, and to deliver technical programmes to prevent and control diabetes at the local level. We will continue to raise awareness on how to prevent, where appropriate, and ensure timely medication and management for people living with diabetes”.