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This section provides analysis of the survey results and discusses both the export of traditional health services and the barriers which impede their attainment. The section is structured into three parts: first, discussion on export potential; second, discussion on barriers; lastly, the implication for the domestic health system of traditional health service exports.

4.1 Export Potential of Traditional Health Services

The survey results from both in-depth interview and FGD in both Bhutan and Nepal, show that there is potential for export of traditional health medicine. The consumer surveys also support this conclusion, but in a more restrained manner due to the nature of the service provider (in Bhutan, the service provider is public while in Nepal, the service provider is private and export oriented). This conclusion is attributed to a number of reasons:

• Natural Features: Bhutan and Nepal are situated in the region of the Himalayan mountain range and therefore benefit from a pleasant climate. This contributes to both the production of quality health products, provision of effective health services, and rest and recovery;

• Historical Advantage: Both countries have a long history in their respective traditional health service. This has generated faith in those health services by

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domestic nationals. This is also the case in the foreign nationals at the service providers, but a note of caution is warranted as this may reflect selection bias. • Clarity in Policy: There already exists a legal structure and clear rules and

regulations which will facilitate incorporation into the health system. This will also lead to credibility in the service provided.

• Treatment Effectiveness and Price Advantage: There is suggestive evidence that some of the treatments are both more effective and healthy (in terms of side effects) vis-à-vis allopathic health services. While the treatment is subsidized by the respective governments, its widespread utilization suggests that it may be relatively less expensive vis-à-vis allopathic health services. This should be particularly attractive to foreign consumers.

• Existence of Skilled Manpower. There is a rich supply of persons with traditional practice. From a formal perspective, institutions exist, e.g. ITMS in Bhutan, while in Nepal there are nine Ayurveda campuses/colleges/institutes running Bachelor’s and Certificate Level classes.

This suggests that traditional health service has export potential.

But, the above analysis implicitly takes trade as that of international trade. The consumer survey had shown that existing trade is mainly at the domestic level: in Bhutan 49 of 50 were domestic nationals while in Nepal the case was 32 of 43. For the Nepal case the result is conditional on the export-oriented nature of the selected traditional health institution, where 74 percent of consumers in 2007/08 were foreigners. Nonetheless, the

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survey suggests that there already exists domestic trade in traditional health services, which indicates at the under-achieved potential for international services trade.

4.2 Barriers and Constraints to Export of Traditional Health Services

The study has highlighted a number of barriers. They are categorized into five groups.

• Trade Facilitation Issues: Transport cost directly affects consumption abroad of both domestic and international trade. There is also a problem with language and customs.

• Information of Traditional Health Services: There is lack of information dissemination on the benefits of traditional health services – both by the public and private sources. This makes the informed choice of health service providers, especially by non-residents, very difficult. At present and in general, decisions have to be made based on word of mouth or through third hand experience.

• Credibility of Traditional Health Services: Faith is a driving factor for consumption of traditional health services. Consumer surveys showed some patients taking recourse to traditional medicine as a last alternative due to failure of allopathic medicine. But, such faith alone is not enough especially when facing international health consumers. There is thus a need of scientific and empirical studies which point to the effectiveness of traditional health medicine.

• Lack of Effective Incorporation into the Formal Health System, contributed by mistrust: Although government rules and regulations provide a veneer of

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formality to traditional medicine and health services, the latter are yet to be effectively incorporated in to the formal health system. Part of the reason is mistrust on the part of providers of allopathic medicine.

• Human Resources and Recognition: the lack of recognition of academic course in traditional health services, such as Nepal’s BAMS, is restraining further enhancement of human resources. Also, recognition has implication for the credibility of health service provision.

4.3 Implications for the Domestic Formal Health System of Traditional Health Services Export

Export of traditional health service and incorporating it into the domestic health system will lead to welfare benefit for the general populace.

The overall effectiveness of health services in the long-term will likely improve. This is because some of the treatments of traditional health services are shown to be more effective than existing allopathic treatments, with less-side effects. Also, the survey also suggests that traditional health service is less costly which, is a contributing factor to its prevalence and use by the populace. Thus, traditional health service can be viewed as an effective complement to allopathic health services.

Incorporation of traditional health services into the formal health system also would put the service under purview of the respective government’s regulatory and supervisory

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mechanism. This would enhance quality of service. This would also ensure better planning by the governments since they have a better grasp of the situation regarding health service provision. It would also likely enhance the tax revenue of the government.

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