Universal Health Coverage (UHC) means that all individuals and communities receive the full spectrum of essential, quality health services without suffering financial hardship. Chugai is supporting the Bhutan Cervical Cancer Eradication Project to contribute to the further advancement of UHC in Bhutan from 2021.

Background
Worldwide, 15 million people die from non-communicable diseases (NCDs) before the age of 70 every year, with 86% of these premature deaths occurring in developing countries*1. Bhutan is no exception. In 2019, NCDs accounting for 71% of reported deaths, while cervical cancer remained as the most common cancer among Bhutanese women*2. According to Bhutan’s population-based cancer registry,
Bhutan has high cervical cancer incidence with age-adjusted incidence rate (AAR) of 20.5 per 100,000 women, and a mortality rate of 5.3 per 100,000
women - one of the highest rates in Asia^*３. Given the rising trends in cervical cancer, Bhutan committed to eliminate cervical cancer. Support mobilized from Chugai Pharmaceutical company, is used to complement the implementation of the National Flagship cancer screening program led by the Ministry of Health, Bhutan. The support was provided in implementing the outreach cervical cancer screening camp in three districts (Haa, Trashigang and Pemagatsel) using the high specific screening test (HPVDNA tests) and capacity development of service providers on use of new screening methods, diagnostics and treatments services.

Main Outcome:
• 11,121 women were screened in 2021- 2022.
• In total 89% of targeted women screened with HPV-DNA test and 3.98% were HPV positive. 　　

Other outcome includes:
• 100% of targeted women screened for Non communicable disease like blood pressure, body mass index.
• All women over 40 years screened for breast cancer. All noticeable anomalies like discharges, prolapses and polyps were recorded and referred for further treatment.
• 100% of female health care providers in these three districts trained on HPV-DNA screening technique and use of online DHS2 platform to enter screening information.

Voice’s from beneficiaries and service providers:

Figure 1:Ms. Gemkit Lepcha, Health assistant, Sakteng Primary Health Center
“I have been posted in Sakteng primary health center for a year and since I never received training on cervical cancer screening, I could not offer pap smear screening to women of my catchment area. This outreach screening camp has given me an opportunity to learn and boosted my confidence to independently provide HPV-DNA test once I am back to my station”

Figure 2:“At first I was hesitant to come as I heard from others about the embarrassment but now, I understand that screening is one of the most effective ways to prevent cervical cancer in women. Though this is my first time undergoing the cervical cancer screening, I am confident to take the test, firstly I will know the status of my health and secondly whatever the results may be there are treatments available” (Pema Lhaden, 26 years, Thangron)

Figure 3:“I never got screened before and at this stage I never thought I would be at the risk of getting cervical cancer. Both my daughter and our village representative insisted that I get tested and after this morning’s IEC session, I know it’s for my own benefit” (Aum Dorji Choden, 60 years, Bidung Gewog)

Video message from Sriram Haridass, UNFPA Representative India & Country Director Bhutan a.i.

Kuzu Zangpola,
Konnichiwa,
Greetings from the UNFPA, Bhutan country office. On behalf of UNFPA, I would like to thank Chugai Pharmaceutical for your generous contribution to UNFPA to support Bhutan's efforts in eliminating cervical cancer. Despite being preventable, cervical cancer remains the most common cancer and one of the leading causes of cancer deaths in young women. Access to cervical cancer screening remains challenging due to difficult geographic terrain, sparse population, lack of awareness and low capacity of service providers. Therefore, this support from Chugai Pharmaceutical for three years will make a significant contribution to UNFPA and the government's partnership to enhance the screening services for women in rural and remote districts. This will be done through outreach screening camps and by strengthening the capacity of service providers which will improve the overall quality of care. This support will also contribute to strengthening the partnership with Bhutan Cancer Society, a non-governmental organization formed in 2015 to enhance access to information on cancer prevention. And with this project special attention will be provided to addressing cervical cancers. UNFPA's partnership with the Royal Government of Bhutan takes back to the early 1970s and the support from Chugai Pharmaceutical will go a long way in our joint efforts to eliminate cervical cancer from Bhutan. So let me thank you once again and say that we at UNFPA people of Bhutan are really grateful for this support. We look forward to your continued support and our collaboration in future.
Kadrinchela
Arigatogozaimasu.


＊1　WHO Noncommunicable diseases
https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

＊2　Annual Health Bulletin 2020, Ministry of Health, Bhutan.
https://www.moh.gov.bt/wp-content/uploads/ict-files/2017/06/health-bulletin-Website_Final.pdf

＊3　Cervical Cancer Elimination - UNFPA Asia-Pacific
https://asiapacific.unfpa.org/sites/default/files/pub-pdf/bhutan_final_16_12_21.pdf