𝐈𝐧𝐭𝐞𝐫𝐧𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐄𝐱𝐩𝐞𝐫𝐭𝐬 𝐄𝐧𝐝𝐨𝐫𝐬𝐞 𝐁𝐡𝐮𝐭𝐚𝐧’𝐬 𝐇𝐞𝐚𝐥𝐭𝐡 𝐏𝐫𝐨𝐠𝐫𝐞𝐬𝐬, 𝐔𝐫𝐠𝐞 𝐀𝐜𝐭𝐢𝐨𝐧 𝐨𝐧 𝐆𝐚𝐩𝐬

…𝒇𝒊𝒏𝒅𝒊𝒏𝒈𝒔 𝒖𝒏𝒅𝒆𝒓𝒍𝒊𝒏𝒆 𝒔𝒕𝒓𝒐𝒏𝒈 𝒄𝒐𝒐𝒓𝒅𝒊𝒏𝒂𝒕𝒊𝒐𝒏, 𝒅𝒂𝒕𝒂 𝒈𝒂𝒑𝒔, 𝒂𝒏𝒅 𝒕𝒉𝒆 𝒏𝒆𝒆𝒅 𝒇𝒐𝒓 𝒍𝒐𝒄𝒂𝒍-𝒍𝒆𝒗𝒆𝒍 𝒊𝒏𝒗𝒆𝒔𝒕𝒎𝒆𝒏𝒕

By Yeshi Dolma

Bhutan is making significant strides in strengthening its health security systems, according to the preliminary findings of the Second Joint External Evaluation (JEE) under the International Health Regulations (IHR 2005). Conducted by Bhutan’s Ministry of Health with technical support from the World Health Organization (WHO), the assessment examined the country’s ability to prevent, detect, and respond to public health threats.

The national evaluation team and an international group of experts assessed Bhutan’s capacity across 19 technical areas, assigning scores from Level 1, indicating minimal capacity, to Level 5, representing fully developed systems. The JEE highlighted Bhutan’s strengths, particularly in vaccination coverage and collaboration with the security sector, while also identifying areas needing further improvement.

Dr. Aulakh Bhupinder Kaur, WHO Representative, commended the Ministry of Health’s leadership in undertaking the evaluation. “This is a timely and commendable step toward strengthening Bhutan’s health systems post-COVID-19. The value of the JEE lies not in the scores but in honest reflection and evidence-based improvements,” she said. She noted that with over 80 experts involved, the evaluation would guide national planning and align investments from the Pandemic Fund. Dr. Kaur encouraged Bhutan to use the findings to update or develop a National Action Plan for Health Security and affirmed WHO’s ongoing support in building a resilient and inclusive health system.

Pemba Wangchuk, Secretary of the Ministry of Health, remarked, “It is a privilege to officially launch Bhutan’s second Joint External Evaluation under the International Health Regulations. This is not just a routine assessment; it is an opportunity to evaluate our readiness to face future pandemics and public health emergencies. Since our first evaluation in 2017, we have made significant gains, but we cannot afford complacency. Our systems must be faster, more coordinated, and more resilient. I call on all national experts to engage fully and use this evaluation to drive urgent, targeted improvements. The health and safety of our people depend on it.”

Among Bhutan’s notable achievements is its national immunization program, which received a Level 5 rating. The WHO experts agreed with the self-assessment, citing the country’s 97 percent coverage of the measles-rubella vaccine in 2023, up from 68 percent in 2018. This progress was attributed to extensive outreach efforts, including health workers traveling to remote areas to reach every child.

Despite this success, international evaluators recommended continued efforts to ensure equitable access, particularly in underserved communities. They emphasized the importance of addressing vaccine hesitancy and enhancing data systems to assess public trust in vaccines.

Dr. Dhrupthob Sonam expressed satisfaction that children in remote areas such as Laya who had missed their measles-rubella doses were also vaccinated. He highlighted that 95 percent of Bhutan’s 12-month-old children have received at least one dose of the measles-containing vaccine, according to surveys and administrative records. He added that for areas slightly below this target, plans are in place to reach 95 percent coverage by 2030.

In the area of risk communication, Bhutan assigned itself a Level 3 score. International experts generally concurred but suggested that some indicators merited lower scores, closer to Level 1 or 2. They noted that misinformation and rumors continue to challenge frontline health workers, especially at the local level. In response, Bhutan plans to implement community training programs, establish permanent risk communication units, collaborate more closely with local media, and incorporate public health messages into literacy initiatives.

“To strengthen Bhutan’s health emergency preparedness, we must designate RCCE focal points, build multi-hazard communication plans, and regularly train frontline teams through practical exercises. Managing misinformation is equally vital. We also face challenges in timely reaching highland and rural communities due to poor connectivity, which must be addressed through improved outreach systems,” stated Ugyen Norbu.

The evaluation also assessed Bhutan’s ability to manage zoonotic diseases, which are illnesses that can spread from animals to humans. Bhutan gave itself a Level 3 for surveillance and Level 4 for response capacity. International experts acknowledged the country’s strong frameworks for tracking and controlling diseases such as rabies. However, they recommended further investment in field operations at the local level, improved coordination across agriculture and wildlife sectors, and strengthened laboratory systems. Bhutan’s team agreed that while national systems are in place, more support is needed at the district level.

Dr. N. Dahal noted, “One of our key challenges in responding to zoonotic diseases is the limited surge capacity at the sub-national level. We lack adequately trained responders, face logistical gaps, and often struggle with consistent risk communication between sectors.”

To reinforce the One Health approach, Bhutan has proposed establishing One Health Committees in at least 50 percent of Zone 5 districts over the next three years. However, international evaluators questioned the practical clarity of this target and advised aligning it with a 2020 executive order that mandates One Health Committees in all districts. They cautioned that the current proposal might unintentionally understate Bhutan’s existing commitments.

Bhutan received a Level 3 score for maintaining essential health services during emergencies. Reviewers acknowledged the government’s organized response during the COVID-19 pandemic, including mobilization of the Bhutan Red Cross Society and the Red Cross Ride for Health initiative. Still, they urged institutionalizing emergency health operations and improving integration of health data systems to prepare for future crises.

Bhutan is expected to become the first country to fully modernize its health information system by adopting the International Classification of Diseases 11th Revision (ICD-11), enhancing care delivery, data accuracy, and planning. However, Dr. Yowaan Thapa pointed out persistent challenges in rural areas, including low health literacy, weak referral mechanisms, workforce shortages, and limited access to services, despite strong primary care networks and mobile health units.

Bhutan’s collaboration with the Royal Bhutan Army and Royal Bhutan Police in health emergency planning earned a Level 5 score. International evaluators praised this coordination but recommended formalizing agreements, regularly updating contact points, and conducting joint simulation exercises to prepare for complex threats such as chemical spills or intentional biological incidents.

International experts consistently noted Bhutan’s transparency, organization, and commitment to public health. They emphasized that the JEE is a collaborative tool, not a ranking, aimed at identifying strengths and gaps in national health security. Bhutanese officials agreed, pledging to act on the findings to improve preparedness.

Deki Yangzom, technical lead, stated, “Bhutan has a strong tradition of collaboration between public health and security forces like the Royal Bhutan Army and Royal Bhutan Police, especially during emergencies. Security agencies are actively involved in national task forces, simulation drills, and emergency operations, with clear focal points and memoranda of understanding supporting joint action. However, challenges remain around coordination, resources, and leadership alignment, which need strengthening to ensure seamless health emergency responses.”

The JEE employs a five-level scoring system to assess public health capacity. Level 1 indicates the absence of formal systems, while Level 5 represents tested and sustainable systems supported by policies and resources.
With the evaluation process complete, Bhutan is expected to finalize a national action plan incorporating the JEE recommendations. The Ministry of Health, with support from WHO and other partners, aims to build on progress made and further strengthen national resilience against future public health emergencies.