Mental Health in Bhutan
Many often call Bhutan “The Happy Kingdom.” The reality, though, is that despite its renowned holistic development philosophy, it is struggling with a severe mental health crisis. Suicide is the sixth leading cause of death at a rate of one almost every 90 hours. However, luckily five organizations are addressing mental health in Bhutan to help alleviate them.

About Mental Health in Bhutan

Among its population of almost 780,000, in 2020, 6,858 cases of mental and behavioral disorders were on record. Meanwhile, infrastructure and licensed professionals are scarce. Only 100 beds exist in the 63 community-based psychiatric units around the country and there have only ever been four psychiatrists working there to date. This translates to roughly one psychiatrist for every 200,000 people, which is similar to Indonesia and India (0.6 psychiatrists per 200,000 people) compared to the United States (33 per 200,000).

Like much of the world, mental health services largely do not receive enough funding. Only 1% of Bhutan’s total health expenditure goes toward mental health. Superstitious and traditional beliefs that mental illness are due to black magic and curses still result in people turning to alternative practices and religious healing.

Addressing the acute need for more mental health professionals, services and infrastructure, these five organizations are at the forefront. Here are the five organizations addressing mental health in Bhutan.

5 Organizations Addressing Mental Health in Bhutan

  1. The Bhutan Canada Foundation: In 2019, The Bhutan Canada Foundation brought together Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) and the Global Health Initiative (GHI) at the University of British Columbia to tackle mental health. This university organization partnership works to generate educational dialogue and skill building for mental health and held a three-day symposium in 2020 focused on reducing mental health stigma, suicide prevention and building resilience.
  2. Health Volunteers Overseas: Health Volunteers Overseas have been working in Bhutan since the early 1990s and in 2009 expanded its initiative by implementing a mental health project. The HVO Bhutan mental health project focuses on improving both access and quality of care by training and educating professionals. Volunteer psychiatrists, psychologists, psychotherapists and clinical social workers at the Jigme Dorji Wangchuck National Referral Hospital and the Royal Institute of Health Sciences train the students and staff involved in mental health care.
  3. RENEW: RENEW (Respect, Educate, Nurture and Empower Women) is a nonprofit organization that Her Majesty, The Queen Mother Sangay Choden Wangchuck, founded in 2004. It focuses on empowering women and children and works with domestic abuse survivors and gender inequality. The organization also offers counseling services for abuse survivors dealing with mental health concerns. In September 2021, RENEW partnered with the Bhutan Board of Certified Counselors and the UNFPA to hold a six-day mental health facilitator training and another in October 2021. These events each trained more than 20 individuals.
  4. The UNFPA-PCE: In 2009, the United Nations Population Fund partnered with Paro College of Education to generate awareness, advocacy and dialogue on mental health as well as gender-based violence and developmental issues. It has published books and conducted workshops for students and psychological community outreach. In March 2020, multiple initiatives emerged to promote youth psychological and emotional resilience in response to COVID-19. The following year, a UNFPA-PCE partnership Center for Knowledge, Advocacy and Dialogue emerged to create a larger community base in the country.
  5. The Pema Center: The Pema Center is a new endeavor that the government funded to tackle mental health. It is a 60 bedded hospital currently undergoing construction that will dedicate itself to mental health and wellbeing. It consists of three main divisions – self-harm prevention, violence prevention and response, and substance use prevention and care. This organization began in response to mental health concerns due to the COVID-19 pandemic when reports showed that depression cases had doubled. It aims to provide both prevention, intervention and aftercare along with helpline, follow-up, rehabilitation and awareness-building services. The center has been conducting mental health screenings at schools, colleges and workplaces to counter the adverse effects of late identification. Late identification of mental health diseases is largely due to stigmatization and a lack of screening services and results in more severe and undiagnosed cases.

The National Mental Health Program

In July 1997, the government launched its National Mental Health Program, to integrate mental health into general health care. Mental health personnel now receive training in public health care facilities, allowing patients to receive both mental and physical care within the same visit, reducing mental health stigma and building community awareness.

More recently, Her Majesty, The Queen Mother Sangay Choden Wangchuck, has vocalized the need to make mental health a national priority, pushing for more government initiatives to better Bhutan’s mental health services. Along with the country’s health ministry, these organizations light the path towards an increasingly healthy population.

– Serena Sahiba Singh
Photo: Unsplash

COVID-19 Vaccination in Bhutan
COVID-19 vaccination in Bhutan began in March 2021. The long-term impact of COVID-19 remains limited to an economic slowdown from the country’s lockdowns. This is allowing the government to smoothly pivot to its long-term recovery goals.

Bhutan’s citizens are responsible for the global pandemic’s minimal impact on the Bhutanese population’s health. There was a consistently high amount of attention toward preparing response efforts. A high level of lower-income communities in Bhutan’s outskirts has expressed the country’s willingness to help its worst-off endure the crisis.

COVID-19 and Vaccinations in Bhutan

Reuters’ COVID-19 Tracker and its latest data from July 8, 2021 indicate that Bhutan’s infection rate stands at an average of 21 new cases each day. Broader statistics are a testament to successful containment efforts. The relatively small country’s 763,000 citizens boast a mere 2,249 infections and only one fatality. Meanwhile, vaccination rates trend at 92 doses per day. However, this is because the Bhutanese government already distributed its vaccine stockpile to an overwhelming majority of its citizens.

As a nation that uses the philosophy of “Gross National Happiness” as a guide, a ready amount of native volunteers answered the call to bring vaccines to those in need. Avoiding a national health crisis means enduring an economic slowdown. However, Bhutan’s most vulnerable citizens can expect a consistent level of support while recovery continues. A hallmark of this success is its sheer rapidity. For example, “…within two weeks, it had reached more than 90% of the adult population eligible for vaccination,” observed The Lancet in its retrospective on how COVID-19 vaccination in Bhutan led to distributing the first of two doses.

Garnering Vaccines

Bhutan did not receive its total Covishield supply all at once. The first shipment of aid from India arrived in the form of 150,000 doses on January 20, 2021. Rather than delivering vaccinations in a staggered fashion as new doses arrived, the Ministry of Health selected March 27, 2021 to begin distribution due to the day’s astrological significance.

This decision left enough doses available to completely sidestep the issue of managing a chain of priority groups for the first wave of COVID-19 vaccination in Bhutan. Combining this with a willingness to confront the challenges of shipping Covishield to rural areas resulted in poorer communities facing relatively insubstantial delays.

Participatory Spirit

While the practical hurdles of COVID-19 vaccination in Bhutan stem from its public servants’ sound preparation, the dearth of registrations is a credit to the government’s ability to mobilize its population. In this respect, further Ministry of Health action in the two months before March 27, 2021 encompassed a campaign to invigorate national spirit concerning the vaccine.

Aside from the publicity of choosing to begin distribution on an auspicious day, The Lancet reports on a series of regular broadcasts by Prime Minister Tshering to provide facts on the vaccine and ward off misinformation that could increase hesitancy to register. “It helps in making rational and well-informed decisions when you have in-depth knowledge of the subject yourself,” says Health Minister Lyonpo Dechen Wangmo on his government’s attention to keeping medical expertise at the center of its strategy.

Bouncing Back

Now that the immediate danger of an unvaccinated population has passed, the long-term benefits of resolving this crisis are apparent. Despite what the Bhutan Times characterizes as “challenging circumstances” over the course of 2020, it nonetheless describes progress toward achieving its development goals as “tremendous.”

A series of initiatives with the United Nations illustrates an optimistic attitude for the future as the economic climate slowly becomes more conducive to attracting young and newly enfranchised demographics to growing sectors of the economy. Plans are in development to a self-sufficient agricultural sector in line with 2030’s Sustainable Development Goals (SDGs), with the pandemic’s economic impact doing little to slow Bhutan’s process of positive systemic change.

Samuel Katz
Photo: Flickr

Bhutan Healthcare
The Bhutan healthcare system worked wonders during the COVID-19 pandemic, only experiencing one death by January 2021. Its rapid-fire contact tracing, reliance on science and trust in government led to one of the best pandemic responses the world has ever seen. The success of healthcare in Bhutan indicates great progress in a healthcare system that has seen more than its fair share of struggles.

How Does Bhutan Run its Government and Healthcare System?

Bhutan, a Buddhist nation of just over 750,000 people, is between China and India. After a long period of underdevelopment, with legalized slavery until 1958, Bhutan has dramatically progressed through the course of 12 Five Year Plans (FYPs), currently scheduled through 2023. In 2008, the nation adopted a constitutional monarchy.

Bhutan is famous for its use of the Gross National Happiness Index. Every Five Year Plan discusses what changes the nation must make, as well as what priorities it should adopt, in order to maximize the GNH index. Bhutan’s entire government, along with its healthcare system, runs with the goal of promoting nationwide happiness and well-being. Bhutan utilizes a system of universal free healthcare, which it finances with approximately 3.5% of its GDP. There have been many significant health breakthroughs in Bhutan, between the near-eradication of vaccine-preventable diseases and the provision of an equitable healthcare supply. However, the system has encountered and continues to face several difficulties.

Issues Regarding Healthcare in Bhutan

Modern health struggles have accompanied Bhutan’s modernization; instead of malaria and polio, Bhutan now faces addiction, mental illnesses, HIV/AIDs and other serious problems. Specifically, the three most pressing concerns are systemic healthcare problems, noncommunicable diseases and mental health issues. Bhutan’s healthcare system faces challenges itself. Most prominent is a lack of proper recordkeeping, unequal access to care (despite having equal supply) and inadequate providers.

First, Bhutan does not properly record most of its health difficulties. This lack of data leads to increased difficulty in making progress. The Five Year Plans cannot satisfactorily address problems that the Bhutanese government does not know are occurring. Second, facilities face large discrepancies in their quality of care and certain settlement areas do not receive enough information about the nation’s healthcare options. Just because there is equitable supply does not mean that all in the nation have access to or know to utilize the care that Bhutan’s government provides.

Third, Bhutan employs underqualified healthcare workers. While a lack of reports means that the international community is unaware of the exact problems the Bhutanese population encounters, as well as how many in Bhutan die due to dangerous healthcare, the World Health Organization (WHO) estimates that millions die globally because of unsafe medical care and that around half of these deaths are preventable. A study that the British Medical Journal Open (BMJ) published found that Bhutan’s healthcare system’s most prominent failings have been due to inadequate skills, training and attitudes among providers.

Health Problems in Bhutan

Furthermore, non-communicable diseases account for 53% of all deaths, and they are the leading cause of death across all age groups. Cancer, diabetes and traffic injuries have replaced the falling number of deaths from STIs. Despite working out of a framework dedicated to happiness, Bhutan ranks 20th on a list of countries regarding their rate of suicide. Combined with addiction and other mental health struggles, this is an area where Bhutanese healthcare faces an extreme care deficiency.

Bhutan did not employ its first psychiatrist until 1999 when Bhutan-born and Sri Lanka-trained Dr. Chencho Dorji returned to the nation. As of 2013, the majority of more than 5,300 Bhutanese psychiatric patients have fallen onto the shoulders of Dr. Chencho. As of the 2020 survey, Bhutan only employs 116 in the department of therapy — that is, barely more than 0.015% of its population. To put this number in context, 0.03% of the United State’s population are licensed therapists. Nevertheless, plenty of reasons exist for one to be optimistic about Bhutan’s healthcare system.

Optimism About Bhutan’s Future

Bhutan has multiple ways to resolve the healthcare problems it is currently facing. For example, the BMJ study focused on collaboration, resources and governance, but a better way of looking for optimism could be to investigate what the Five Year Plan prioritizes. Prioritization in the FYPs produced all of Bhutan’s historical healthcare successes, and there is no reason to predict otherwise for current crises. The 12th Five Year Plan, in effect from 2018 to 2023, provides solutions to the struggles of healthcare in Bhutan.

About the 12th Five Year Plan

First, the 12th Five Year Plan addresses problems in data recording as discussed at the 11th FYP’s mid-term review, prioritizing proper data collection for the new term to accurately perceive what problems need attention. Bhutan’s excellent COVID-19 response showcased success in this area. Second, the fight against non-communicable diseases (NCDs) worked its way into the forefront of Bhutan’s healthcare policy and is clearly a priority in the 12th Five Year Plan. Bhutan shares the international goal of eradicating tuberculosis by 2035 and recognizes both cures and treatments of NCDs as a dire need. Third, the FYP expanded from its four pillars of a just society to nine domains. The new domains include living standards, education, health, psychological well-being, cultural resilience, ecological diversity, among others.

The plan accounts for other systemic issues in the Bhutan healthcare system as well. One of the central means of progress that the FYP outlined is decentralization. By allocating funding to local governments to more comprehensively provide care throughout the nation, Bhutan will see a rise in equitable access to care — not just supply. Additionally, the 12th FYP details increased provider training.

Some of the new domains, including creating a charitable culture and regulating time allocation between work, sleep and other activities, work directly to combat mental illness. Psychological well-being places focus on providing adequate treatment to those who are still struggling despite those domains. New policies and priorities outlined in the 12th FYP provide hope for one of the fastest developing healthcare ministries globally.

Looking Ahead

There are certainly kinks in healthcare in Bhutan that the country must work out. However, with the changes in the Five Year Plan, the system of healthcare seems to be leading the way to a very bright future.

The only factor holding back this optimism is Bhutan’s limited resources. But, Bhutan underwent a great economic change, raising its GDP at an annual average of 7.5% just two decades after emancipation. As one of the fastest-growing economies in the world, its health services have seen great progress and continued to grow with time.

If a small, underdeveloped country with a great resource shortage can successfully implement a healthcare system that specifically focuses on its citizens’ happiness, perhaps this system could inspire a seismic shift in the way government runs. Bhutan has set a precedent for designing a world where the population’s happiness is the government’s main priority and, with adequate funding, it could more thoroughly achieve these goals. Now, it is time for the U.S., France, Germany, the U.K. and other global democratic superpowers to step up and do the same.

– Sam Konstan
Photo: Flickr

Bhutan’s Gross National Happiness
Over the last two decades, Bhutan has made remarkable progress towards reducing national rates of poverty. The key to its success? Happiness. At the core of its development philosophy is Bhutan’s Gross National Happiness (GNH) — the idea that sustainable development requires a holistic approach and needs to take into consideration all aspects of well-being.

The Origin of GNH

The phrase was first coined by King Jigme Singye Wangchuk, the fourth king of Bhutan, in 1972. He declared that “Gross National Happiness is more important than Gross Domestic Product.” Bhutan created the GNH Index, a measurement of well-being, to use in policymaking. The GNH Index does not measure happiness alone, but also the overall well-being of Bhutanese citizens. It includes nine domains:

  1. Psychological Well-being
  2. Health
  3. Education
  4. Time Use
  5. Cultural Diversity and Resilience
  6. Good Governance
  7. Community Vitality
  8. Ecological Diversity and Resilience
  9. Living Standards

Each domain falls under one of four pillars: (1) good governance, (2) sustainable socio-economic development, (3) cultural preservation and (4) environmental conservation. The United Nations’ Sustainable Development Goals, aimed to be accomplished by 2030, fit well together with the GNI. Out of the 17 Sustainable Development Goals, 16 of them fall under one of the GNH pillars.

Developments in the GNH

In 1990, Bhutan had roughly the same levels of poverty as other South Asian countries, with more than 50% of the population living in poverty. By 2010, Bhutan reduced its rate of poverty to just 4%, while poverty for South Asia, on the whole, dropped to 30%. Although people are falling back into poverty, Bhutan has made tremendous progress towards poverty reduction through its holistic developmental approach.

Reforms that helped to improve the standard of living through various five-year-plans and programs include the commercialization of agriculture, development of infrastructure and increased amount of hydropower projects. The commercialization of agriculture led to about 8% annual growth in crop production per hectare. Moreover, the creation of more roads and highways increased access to education. Notably, much of the poverty reduction has taken place in rural areas, while in urban areas there is a danger of poverty increases.

Hydropower and Carbon Emissions in Bhutan

The main driver of wealth in rural areas is hydropower projects. Almost all of Bhutan’s energy comes from hydropower and the country even sells hydro electricity to neighboring nations. This is a major reason why Bhutan is the only country in the world that is actually carbon negative. This means that it absorbs more greenhouse gases from the atmosphere than it produces. The small population size, larger forest cover, relative underdevelopment and use of clean energy make Bhutan a carbon sink rather than a source. This is a remarkable achievement; Luxembourg, which is even smaller than Bhutan, emits four times the amount of carbon. The nation’s (Bhutan’s) lack of carbon emissions falls under the environmental conservation pillar of Bhutan’s Gross National Happiness. Yet, it also contributes to economic prosperity and development through hydropower projects.

Bhutan takes a wholly unique approach to govern its citizens by focusing on their happiness. The 1629 legal code of Bhutan states that “If the government cannot create happiness for its people, there is no purpose for the government to exist.” For hundreds of years, concern for the well-being of its people has informed policymaking. It is the reason why poverty has been drastically reduced, why annual GDP growth is 7.5% and why the country is carbon negative. Countries around the world can draw significant conclusions from Bhutan’s focus on gross national happiness.

Fiona Price
Photo: Pixabay

Poverty in BhutanBhutan is a small country tucked away in the mountainous terrain of the Himalayas. Known as the Kingdom of Happiness, Bhutan is notable for creating its Gross National Happiness Index. This index serves as a tool for the Government of Bhutan to outline what must occur in order to foster and maintain a holistically sustainable environment. To uphold this index, Bhutan has made it a priority to reduce poverty in Bhutan and better the quality of life for the population.

Poverty in Bhutan

Poverty in Bhutan stems largely from issues with the country’s terrain. The Himalayas, while beautiful, are also difficult to cultivate, traverse and control. Farmers struggle to grow enough crops to maintain a stable income due to the limited access to farmable land. What workable land there is, often rests at the whims of various natural disasters. The lack of education and diverse job opportunities also have made it difficult for many to rise out of their economic situation without help and intervention.

Over the last 10 years, the government has made impressive strides to address poverty in Bhutan. Between 2007 and 2012, poverty dropped from 23% down to 12%. In 2017, Bhutan announced that it had once again cut its poverty rate by half over five years, dropping the number down to 5.8%.

Strategies and Improvements

The value of land productivity has been rising and thus, farming has become a more profitable and sustainable industry. Bhutan cultivates less than 3% of its land but the country has shifted to producing high-value commercial crops. These crops sell for a high price with countries such as India and Bangladesh, making up for the lack of farmable land. Trade agreements have stimulated the value of agricultural exports, increasing the international cash flow into Bhutan’s own economy.

Infrastructure and road production have become vital players in the reduction of poverty in Bhutan. The Government of Bhutan set out to update existing paths, develop new highways and ensure that no town is more than a half-day walk from the closest road. High-quality roads allow for traffic both through and out of rural areas. This increased traffic to urban areas provides easier access to jobs, education and other opportunities for those who previously struggled with inaccessibility.

Hydroelectric projects also play a sizeable role in Bhutan’s efforts to fight poverty. These projects have not only stimulated job growth within rural communities but have also brought in many foreign workers. The presence of these workers increases local spending, benefitting rural communities with income.

Looking Forward

Over the last decade, the rate of poverty in Bhutan has fallen to new lows. While there are still many in the country that struggle with poor living conditions, the government is working to ensure that they too will benefit from the economic changes that Bhutan is trying to normalize. The Gross National Happiness Index accounts for all the people of the country and thus, Bhutan will continue to work at helping its people until all are holistically happy.

Nicolette Schneiderman
Photo: Flickr

Homelessness in BhutanThe small kingdom of Bhutan dedicates itself to maintaining the happiness of its people. It created the Gross National Happiness Index, a tool for measuring the comfort of the population. With this tool, Bhutan’s government aims to provide a particular quality of life for the population. In order to do so, the country remains isolated in the modern age. It allows only a select few tourists to enter the country annually and monitors what kind of technology makes it past the borders. In a country that dedicates itself to ensuring the wellbeing of its people, what is the homeless population like? Many view Bhutan as a beacon of admirability, believing that there are practically no homeless people. International reporting often focuses on how homelessness in Bhutan is virtually nonexistent.

The Hidden Issue

There is another side to the topic of homelessness in Bhutan though. Kuensel is the national newspaper of Bhutan and has published multiple articles covering cases of homelessness within the country. The newspaper has continuously attempted to source the reasons behind why some people in a country so focused on happiness find themselves on the streets. Kuensel uses its inside perspective to try to shift focus away from shining solely on Bhutan’s successful numbers. Instead, he shifts it toward what still needs to be done.

Environmental Disasters and Accidents

One reason that Kuensel found has to do with environmental disasters and accidents. In 2013, a landslide destroyed the home of a family of five and subsequently forced them to live in a small shed. Three years following the incident, the family claimed that Bhutan’s Department of Roads helped to restore some of their land. However, it did not restore their home despite contacting them multiple times. Their story highlighted the lack of congruence between the disenfranchised population and the government’s actions.

Some do not own any land though and find themselves unable to acquire any. Elderly residents that did not inherit land from their parents work trying to scrape by enough money for rations. Often times, they have to beg when they aren’t able to make enough. A 70-year-old man reported to Kuensel that his parents died when he was young with no land to pass down to him. He lives in a rundown makeshift hut, scrounging up firewood and doing what he can to make money for food. He worries that one day, he will lose the few resources he has and have nothing left.

Mental Illness and Unemployment

Mental illness has also become an issue regarding homelessness in Bhutan. Many of the homeless people in Thimphu, the capital of Bhutan, are mentally ill. Abandoned by their families, they subsequently end up in the streets. One case details the suffering of a woman with schizophrenia. Her family supported her as she was a child, but could no longer care for her as an adult. As a result, she ended up living in an abandoned hut in dismal conditions with little to no food. With few mental health resources in the country, mentally ill homeless people often end up neglected and alienated by society.

There is also an issue with rising unemployment rates, particularly among the female population of Bhutan. The overall rate is approximately 2.7% but rises to 7.3% when specifically looking at youths and women. Only 55% of women are literate. When paired with the unemployment numbers, the women of Bhutan are forced to face the threat of poverty and potential homelessness.

Bringing Awareness

There are groups that aim to bring awareness to homelessness in Bhutan though. All for One and One for All (A11A) is a group that assists those who find themselves on the streets by linking them with healthcare workers. Lhak-Sam, an organization originally meant to aid those with HIV in Bhutan, has also opened a care house for the homeless population. It hopes to develop the center so that it can provide mental, physical and emotional aid to those who rely on its services.

However, these efforts are not sustainable in the long-run without assistance. Bhutan may not have a large homeless population, but the suffering of those who find themselves with nowhere to go is generally unheard. With more international awareness, groups such as A11A and Lhak-sam may be able to receive the aid from both the Bhutanese government that they need.

Nicolette Schneiderman
Photo: Pixabay

Sanitation in BhutanAccess to functioning sanitation is critical for maintaining a healthy population and increasing lifespans worldwide. Countries facing sanitation challenges are more susceptible to health challenges, and Bhutan is no different. Here are 10 facts about sanitation in Bhutan.

10 Facts About Sanitation in Bhutan

  1. The Royal Government of Bhutan recognizes sanitation as a right, and its constitution obliges it to provide a safe and healthy environment for its citizens. However, only 71 percent of people in Bhutan had access to improved sanitation as of 2016 according to a government report. The report also notes that safety management is necessary to maintain basic sanitation even in these areas. UNICEF reports that 63 percent of the population has access to basic sanitation facilities.
  2. Many girls in Bhutan miss school due to hygiene and sanitation concerns. A recent study reported that around 44 percent of adolescent girls missed school and other activities due to menstruation. They listed a lack of clean toilets and water as one of the primary reasons.
  3. Bhutan has a WASH (water, sanitation and hygiene) program to increase access to sanitation in schools. By working with UNICEF, Bhutan was able to provide 200 schools with improved sanitation as of an evaluation in 2014. During this evaluation, 90.8 percent of respondents surveyed reported that the program improved students’ health.
  4. As of 2016, all schools in Bhutan had at least one toilet. However, 20 percent of schools did not have working toilets, and 11 percent did not have access to improved sanitation. Furthermore, only about one-third of schools had toilets specifically for girls.
  5. Monastic institutions in Bhutan frequently do not have basic sanitation facilities. About 65 percent lack water supply, while 34 percent do not have proper sanitation. This leads to skin infections, worm infestations and other health issues in monasteries and nunneries.
  6. The most common type of sewage treatment in urban Bhutan are septic tanks that discharge into the environment with no treatment or containment. All urban landfills in Bhutan are used as open dumps and are not sanitary landfills capable of containing and treating solid waste. In rural areas, pit toilets are the most common.
  7. Twenty-four sub-districts in Bhutan have access to 100 percent improved sanitation. These sub-districts are located within nine of Bhutan’s 20 districts. A health assistant in Mongar district said that, with 100 percent improved sanitation, the number of cases of diarrhea is falling.
  8. Many people need to be treated for illnesses that could have been prevented with improved access to sanitation. Poor sanitation was responsible for 30 percent of reported health cases in 2017. Healthcare facilities themselves also suffer from sanitation challenges, as 40 percent of district hospitals reported severe water shortages.
  9. According to a report in 2015, over 50 percent of people living in urban areas only had access to an intermittent water supply; a supply that delivered water six to 12 hours per day. Additionally, this water did not meet quality guidelines. In rural areas, only 69 percent of water supply systems are functional.
  10. As of 2017, only 32 percent of the poorest households in Bhutan had access to improved sanitation. This is about three times less than the richest households, of which 95 percent had access to improved sanitation facilities. Government reports recognize that there are disparities in access to sanitation relating to various factors; income, disability, gender and geographic variables can all contribute.

Overall, these 10 facts about sanitation in Bhutan demonstrate that the sanitation, water and hygiene conditions are quickly improving in the country. Initiatives by the government, UNICEF and other nonprofits in the country have led to substantial positive changes. However, inequality in access to improved sanitation services remains a major issue, and Bhutan still has a long way to go to provide improved sanitation throughout the entire country.

Kayleigh Crabb

Photo: Pixaby

Hydropower Development in BhutanBhutan is the world’s first, and only, carbon-negative country thanks to its focus on clean energy and environmental protection. Countries that are defined as carbon-negative absorb more carbon than they produce, rendering the net amount released negative. This is partially due to the over 70% of tree-covered land that absorbs carbon and Bhutan’s strict environmental sustainability initiatives. One form of clean energy that has allowed Bhutan to achieve this status is hydropower. Hydropower is also the country’s major export and main economic driver.

Economic Benefits

Hydropower has existed as a major sector in Bhutan’s economy since the 2000s, as it accounts for 27% of Bhutan’s revenue and about 14% of its GDP. In fact, Bhutan produces so much energy from hydropower that about 80% of its surplus power is exported to India.

The hydropower potential in the South Asian country of 765,000 people is found in Bhutan’s many powerful rivers in the Himalayan Mountains. There are at least five operational hydropower plants generating more than 1,600 megawatts (MW) of power. However, this is only a fraction of what the country can generate. Bhutan’s hydropower potential is estimated at 30,000 MW, and of that amount, 23,760 MW is considered economically feasible.

Recent Developments

In order to reach the hydropower potential goal, more plants are in the work. Punatsangchu I and II, Nikachu and Khonlongchu are four such plants that will provide an additional 2,000 MW. This would double the amount of hydropower already produced in Bhutan. The projects will be complete within the next two years and strengthen past successes. The Mangdechhu plant (producing 720 MW) was completed in 2019 and is the most cost-effective power plant in South Asia.

However, Bhutan’s terrain is difficult to traverse when constructing hydropower plants, so completing an economically feasible project is rare. The proposed 2,585 MW Sankosh plant received grant money from a partnership between Bhutan and India in 2017 and will be the largest hydropower project in the region. The project will cost $1.65 billion, which is an ambitious and expensive project for a small country with a GDP of $2.3 billion. The project indicates the country’s push to continue hydropower development in Bhutan. Although Sankosh is still under discussion, the massive project could help Bhutan’s economy and lead to job growth once the dam begins construction. Hydropower projects usually involve hundreds of millions of dollars, yet the revenue earned by exporting surplus power covers the high cost in the long run.

Gross National Happiness

Although hydropower development in Bhutan appears to help its economy, the excess power is also used to help those who lack the means to afford electricity. Free electricity is provided to rural farmers, which also prevents the need to use wood and gasoline for fuel. Bhutan has had a 99% electricity rate since 2017, which is a big jump from 61%  in 2006. More than 95% of Bhutan’s electricity comes from hydropower. The country’s focus on clean energy is why it’s a carbon sink; trees absorb all the carbon produced by its people.

Bhutan’s economic development since 1972 is based on Gross National Happiness (GNH), a unique political initiative that guides the country’s development in every area. The four pillars of Gross National Happiness include environmental conservation, good governance, preservation and promotion of culture and sustainable and equitable socio-economic development. This initiative helped guide hydropower development in Bhutan while also saving the surrounding environment. For example, as part of GNH, at least 67% of the trees in the country must remain according to Bhutan’s constitution. This helps prevent deforestation while keeping carbon out of the air. The country has reached only about two percent of its hydropower potential, yet hydropower development in Bhutan continues to grow.

– Lucas Schmidt

Photo: Flickr

Tourism in Bhutan
The curious case of Bhutan has puzzled social and economic scholars for decades. In 1972, the king of Bhutan, King Jigme Singye Wangchuck, declared that Gross National Happiness (GNH) was more important than Gross Domestic Product (GDP). It is the first and only country in the world to use GNH as a measure of socio-economic development rather than GDP. Bhutan conducts measurements by evaluating nine domains.

Nine Domains of Gross National Happiness:

  • Psychological Well-being
  • Health
  • Education
  • Time Use
  • Cultural Diversity and Resilience
  • Good Governance
  • Community Vitality
  • Living Standards
  • Ecological Diversity and Resilience

The last domain listed above (Ecological Diversity and Resilience) has been the cornerstone of Bhutanese Buddhist ideology for centuries. As such, the Bhutanese government has devoted a large portion of its policy agenda toward the conservation of native wildlife. It is the only country in Asia to have over 50 percent of its natural land guaranteed preservation at all times under its constitution. However, with the recent democratization of the country in 2007 and the subsequent onset of globalization, the young generation that makes up over 60 percent of the population would rather “spend time in front of televisions… instead of at the Buddhist temples or in the forests.”

Youth and Urbanization

The more technological interests of the new generation have sparked concern among the traditional older generation in Bhutan. The youth are moving to the cities in droves and will likely live their lives more disconnected from nature and religion than previous generations. As of 2017, 48.7 percent of the population born in rural areas had migrated to cities in search of education, jobs and a more modern lifestyle. Most of these domestic migrants are between the ages of 25 and 29.

Some expect more rapid urbanization to take place due to this large and sudden influx of people to Bhutanese cities. If the rate of movement remains consistent, Bhutan will have to more than double the amount of land available for urban expansion to have adequate housing to accommodate the influx. Along with housing, Bhutan will also have to expand sanitation facilities, electrical infrastructure, transportation infrastructure, public transit and education facilities. These are factors that many Southeast Asian countries have struggled to expand sustainably. However, this does not mean that environmental factors will become obsolete in order to make these developments.

 Tourism in Bhutan

Tourism is one of Bhutan’s largest industries and it is still growing. According to the Bhutan Tourism Monitor from 2016 to 2017, the country experienced a 22 percent growth in tourist arrivals. Tourism generally sparks an increase in globalization in countries that have largely disconnected from international developments, such as modernization, especially among the youth. As tourism ramps up, cities begin to develop more to entice and accommodate additional tourists. This also creates more jobs and draws in domestic migrants from the countryside, just as Bhutan is experiencing now. However, the cities are not the only attraction for tourists. Tourism in Bhutan consists mainly of ecotourism – people want to experience the beauty of Bhutan’s preserved countryside. Tourism in Bhutan is prompting greater urbanization and interest in modern amenities among the youth; however, it also emphasizes the importance of environmental preservation to Bhutan’s economy.

 Improvements in Rural Communities 

Bhutan has implemented the Remote Rural Communities Development Project (RRCDP) in order to lessen the negative impacts of the youth’s migration to cities. This project “promotes the increase of agricultural productivity development of communities’ access to markets, irrigation, agricultural technologies and community infrastructure” in Bhutan’s six most remote districts. Completed in May 2018, this project has provided roads to communities that have never had them before. The roads give these communities better access to health facilities, schools and markets. Farmers are now able to use trucks to transport their goods rather than walking for days to the nearest market. This development has also contributed to the empowerment of women as a byproduct. Some women, who have never been able to make a single-day trip to the market, are even learning how to drive.

Placing greater importance on the accessibility of rural communities may be a solution to the drain of the countryside. By providing access to more modern comforts like roads and markets, the youth may be less hasty to move to the city. Greater access to these communities also helps tourism in Bhutan and creates more jobs in the countryside. The country is building more retreats and farms are expanding the variety of crops. Nonprofits like the World Wildlife Fund are working with the Bhutanese government to better fund advertising for tourism in Bhutan and make it easier for tourists to access the countryside.

Graham Gordon
Photo: Pixabay

Technological Access in Bhutan

A mountainous landlocked kingdom of 766,000 people, Bhutan has been traditionally been isolated and disconnected from the outside world for a number of centuries, with previous rulers keeping the nation as a “hermit kingdom” prior to the legalization of television and Internet in 1999. Bhutan‘s economy relies heavily on its agriculture and forestry alongside the budding hydroelectricity industry, which has proven difficult due to the mountainous terrain of the country. The country’s main trade partners are India and Bangladesh, with no known relationship with the U.S. or other major U.N. members. The legalization of the Internet in 1999, as well as investments in technological advancement in the mountainous country, is a turning point for the kingdom as the developing technological access in Bhutan is expected to bring the country to the modern era.

Internet Development

Since the Internet’s introduction in 1999, Bhutan quickly was able to quickly build its telecommunication infrastructure and have much of the country connected. Cell phone services began in 2003, with 80 percent of the population owning a cell phone as of 2018, which includes 70 percent of the population that consists of farmers, making Bhutan one of the most connected countries in the world. This jump from the days of being isolated from the world allows the people of Bhutan to communicate both within and outside of the country’s borders.


The continued developing technological access in Bhutan has also seen growth through Bhutan’s own investment into its communication networks. Bhutan‘s internal ICT development includes:

  • implementing protection lines for consumer purchases
  • building stations for mobile carriers and broadcasters and expanding upon broadband connections for wireless connections and private access for citizens
  • investing in cybersecurity and strengthening the overall connection quality

The investments in the internal network lines have allowed Bhutan to quickly connect the nation at a rapid pace. However, challenges remain in terms of developing the rural areas of the country within its mountainous terrain. That said, the government is actively looking at ways to change the status quo.

The National Rehabilitation Program (NRB) and the Common Minimum Program are two examples of initiatives focused on building new facilities and roads as well as easier access to electricity and supplies. Mountain Hazelnuts, a company headquartered in Eastern Bhutan has also made major tech investments for its farms, increasing employment and supplying smartphones for hired farmers that help with directions on the road and improve communication.

Henry Elliott
Photo: Flickr