The Gross National Happiness Framework and the Health System Response to the COVID-19 Pandemic in Bhutan

Impact of COVID-19 on mental health in Bhutan: a way forward for action

The coronavirus disease 2019 (COVID-19) pandemic continues to impact mental health and wellbeing globally. There is a lack of scientific documentation highlighting the mental health impact of COVID-19 in Bhutan. We present the mental health burdens and control measures taken, and suggest ways to further strengthen mental health services in Bhutan. During the pandemic, a rise in depression and anxiety had been reported in Bhutan. Depression rose from an average prevalence of 9 per 10,000 between 2011 and 2019 to 16 per 10,000 in 2020 and 32 per 10,000 in 2021. Similarly, anxiety rose from an average prevalence of 18 per 10,000, to 29 per 10,000 in 2020, and 55 per 10,000 in 2021. Psychological impacts related to isolation due to lockdowns, economic losses, and poor coping abilities were associated with negative outcomes. Stigma and discrimination towards mental health disorders discouraged mentally distressed people from seeking care. In response to increased demand, Bhutan’s government initiated a range of interventions including home delivery of medicines and tele-counselling to people in need of urgent mental health care. Mental health care in Bhutan can be further improved through investment in services and human resources, and decentralization of services to the community.

A systematic review of strategies adopted to scale up COVID-19 testing in low-, middle- and high-income countries

OBJECTIVE

We undertook a systematic review of strategies adopted to scale up COVID-19 testing in countries across income levels to identify successful approaches and facilitate learning.

METHODS

Scholarly articles in English from PubMed, Google scholar and Google search engine describing strategies used to increase COVID-19 testing in countries were reviewed. Deductive analysis to allocate relevant text from the reviewed publications/reports to the a priori themes was done.

MAIN RESULTS

The review covered 32 countries, including 11 high-income, 2 upper-middle-income, 13 lower-middle-income and 6 low-income countries. Most low- and middle-income countries (LMICs) increased the number of laboratories available for testing and deployed sample collection and shipment to the available laboratories. The high-income countries (HICs) that is, South Korea, Germany, Singapore and USA developed molecular diagnostics with accompanying regulatory and legislative framework adjustments to ensure the rapid development and use of the tests. HICs like South Korea leveraged existing manufacturing systems to develop tests, while the LMICs leveraged existing national disease control programmes (HIV, tuberculosis, malaria) to increase testing. Continent-wide, African Centres for Disease Control and Prevention-led collaborations increased testing across most African countries through building capacity by providing testing kits and training.

CONCLUSION

Strategies taken appear to reflect the existing systems or economies of scale that a particular country could leverage. LMICs, for example, drew on the infectious disease control programmes already in place to harness expertise and laboratory capacity for COVID-19 testing. There however might have been strategies adopted by other countries but were never published and thus did not appear anywhere in the searched databases.

Surveillance and pandemic governance in least‐ideal contexts: The Philippine case

This paper inquires how surveillance manifests in least‐ideal contexts (LICs), that is, countries with resource constraints, poor governance and proclivity for populism during COVID‐19, and its implications for crisis governance. Using the Philippines as a case, we advance three arguments. First, LICs can become spaces where inappropriate surveillance is undertaken. Second, liminal surveillance practices can become permanent policy fixtures in LICs. Finally, when a prevailing crisis approach of a government is perceived to be inconsistent with the needs of the public, it can lead to a self‐help system among various societal groups and actors. This self‐help system may not necessarily be aligned with the general direction of the national government. As a result, it can perpetuate a disjointed and maladaptive crisis governance approach, where main actors like national governments, and complementary actors like private sector firms, local government units and citizen organizations pursue goals independent of one another.

Control of travel-related COVID-19 in Bhutan

Bhutan—a landlocked country in South Asia—has reported 3381 COVID-19 cases per million population and three deaths until August 2021. The country implemented stringent public health measures to prevent widespread outbreak of COVID-19. This paper describes travel-related measures taken by Bhutan and discusses the way forward after COVID-19 vaccination.

Self-learning on COVID-19 among medical students in Bhutan: A cross-sectional study

Background

Bhutan lacks a medical school and all medical students are trained in Sri Lanka, Bangladesh and India. When the COVID-19 pandemic led to the closure of medical schools in these countries in March–April 2020, the medical students were repatriated to Bhutan. Upon return, they were kept in government-sponsored facility quarantine for 21 days. This study assessed their knowledge on COVID-19 as a part of self-learning and their attitude towards participation in government's health response to COVID-19.

Methods

This was a cross-sectional study among medical students who had returned to the country. The survey was conducted through an online questionnaire while the students were in facility quarantine. The sample size calculated was 129 and convenient sampling was used. Knowledge was assessed using 20 questions, each scored 1/20. Knowledge was considered “good” if the cumulative score was ≥80%, “satisfactory” if ≥60–79% and “poor” if <60%. Correlation between knowledge score and duration of clinical clerkship was tested using Pearson's correlation coefficient. Attitude of students towards their willingness to participate in the national COVID-19 response was tested using rating scales. Data were analysed using Stata 13.1.

Results

120 medical students responded to the survey (response rate = 93%). Eighty-eight (74%) had good knowledge, 28 (23%) had satisfactory knowledge and only four (3%) had poor knowledge on COVID-19. The students scored high on the symptomatology, mode of transmission, prevention and treatment options and on local epidemiology; and scored low on the forms of mechanical ventilation and on home-management of non-critical cases. The knowledge score correlated with the duration of clinical clerkship they had undertaken (r = 0.326, p = 0.001). The primary source of information were social media sites (102, 85%), television (94, 78%) and newspapers (76, 63%). The majority (78, 65%) were willing to participate in the government's COVID-19 response but could not identify what roles they could play. The fear of contracting COVID-19 was reported by eight students (7%).

Conclusions

Medical students had good knowledge on COVID-19 and had self-learned through social media, television and newspapers. The students held positive attitude towards participation in the government's COVID-19 response.