PROGRESS REPORT: The National STH Programme in BHUTAN Mr. Sangay Thinley 2014 RPRG Meeting Jakarta, Indonesia 23 – 24 Sept. 2014

Background Information Geography and Population – Total population: 7,33,003 (Bhutan at a Glance, NSB, 2013) – 38, 394 Square kilometers – 70% forested – Elevations of 160m – 7000m above sea level – 31% of the population (0-14Years) – Ecological zones: Alpine; Temperate; and Subtropical Zone.

Community 437 Outreach Clinics 1200 Village Health Workers Tertiary (1 National and 2 Regional Referral Hospitals) Secondary 32 Hospitals, 20 Basic Health Units-I Primary 185 Basic Health Units- II Health Care Delivery System 3-tier service delivery system supported by community engagement at basic levels and government sponsored referral abroad. Traditional Medicine “integrated part of the health care system. ”

Historical Perspective Brief history of intervention: 1985, 1986 & 1989 Surveys  25.7% ascariasis (Most common parasitic disorder)  4.3% Hook worm infestation in school children  20% to 70% STH prevalence. National Anaemia Survey (2002)  81% of child 6-36 months are anaemic Anaemia Study among school children (2003)  69% of children as anaemic Survey of intestinal Worms in school children 2003 (Western region)  Prevalence of 16.5 % STH infection (226 children in 5 Schools)  6.7 % tape worm infection.

National programme overview IndicatorSTH Year of inception of the national programme1991 (De-worming policy came into place) De-worming in place since 1988 Target date for eliminationAchieve regular treatment to at least 75% of all school children (2010) Name of administrative unit for implementation of PCSchools Total # administrative units requiring PC at the start of the programme NA Total population requiring PC in the countryPre-SAC requiring PC + SAC requiring PC: School children as of 2013 = 1,72,391

Baseline Mapping STH Prevalence & Intensity The intestinal worms incidences and total morbidity by gender is being reported monthly through activity report (BHIMS) Incidence per 10,000 under 5 children: 186 in 2011; 133 in 2012; 125 in 2013(Annual Health Bulletin, MoH). Total Morbidity: 6869 (U15 =1913)

Morbidity trend for the last 5 years YearIntestinal Worms incidence ( Per 10,000 under 15 children) Remarks (U5) 8611 (Above 5) (Consistent decreasing trend) Source: BHMIS

Programme Financing for STH Contributors to the 2013 programme costs (and rough estimate of contributions by each if available): ContributorFunding (US$) National government0.025mn Sub-national governmentNA Internal donors (___)NA External donors (___)NA Others (___)NA

PC programme achievements 2013 Activities TargetedAchieved # administrative units for PC # people # administrative units for PC # people PC T3 (ALB/MBD) for STH 1 st round 5541,72, ,46,608 T3 (ALB/MBD) for STH 2 nd round 5541,72, ,46,608 M&E Total # sentinel sites surveyed (STH/SCH) 00

Progress Towards STH scale up *Coverage =

PC coverage, 2013 *75% for STH **reported coverage was verified by coverage survey or similar independent activity *** PC type # administrative units receiving PC # administrative units with reported coverage above target* # administrative units where coverage was verified** T3 (ALB/MBD) for STH 1 st round T3 (ALB/MBD) for STH 2 nd round***

PC Monitoring and Evaluation Describe how coverage is monitored  Term reports SAE protocol – Detection – Management – Reporting

Best Practices Describe interventions and/or M&E activities that worked well 1.Integrated activities:  Integrated services through PHC approach at all health service delivery centers  Safe drinking water supply scheme and sanitation promotion (WASH)  Bi-annual Health screening of school children  De-worming of children

Challenges and “Issues” No STH Programme Inconsistent reporting from the schools Lack of coordination between stakeholders Frequent change in personnel at the Programme level

Programme Plan Activities 2014 target2015 target # administrative units for PC # people # administrative units for PC # people PC T3 (ALB/MBD) for STH 1 st round T3 (ALB/MBD) for STH 2 nd round M&E # districts where coverage surveys are planned for any PC diseases 00 # districts where STH survey integrated with LF TAS planned 0000

PC medicine request for 2015 ALB (for STH)MBD required in stock (As of 20 Sept 2014) in pipelineNone requested to WHO157,200 Procured from other sources (source, # tablets and target age group) None