Elimination of cervical cancer and related morbidity and mortality in the context of Universal Health Coverage in Bhutan

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. 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. 

• Background
  Building on the success of the initial UNFPA-Chugai partnership*¹, the second phase*²expands support to the Ministry of Health to accelerate cervical cancer elimination with focus on improving the quality of screening and treatment through support to develop and institute service guidelines, develop capacity of health care providers specifically cytotechnicians, pathologists on improving the diagnostic accuracy, nurses involved in screening and treatment, medical doctors on improved diagnostics/treatments, and strengthening the quality control and reporting system and research. To effectively implement the Ministry of Health of Bhutan’s National Cervical Cancer Elimination Strategy, efforts will be advanced across three priority areas: 'screening and early detection’, ‘diagnosis and treatment’, and ‘quality assurance and research’. Through these actions, the initiative aims to strengthen the overall capacity of the health system and achieve significant improvements in the prevention and treatment of cervical cancer in Bhutan.

• Program Summary
  In 2025, Focused on institutionalizing clinical standards and ensuring the sustainable continuity of life-saving cervical cancer screening and treatment services across Bhutan. Through a strong emphasis on in-service training and the implementation of standardized clinical guidelines, the partnership has contributed to building a resilient and well-functioning secondary level of the healthcare system. Key achievements are outlined below.

• Key Achievements

1. Institutionalization of Clinical Standards & Clinical Impact
   The program successfully bridged the gap between policy and practice through the national dissemination of the ‘Practical Guideline on Colposcopy and Treatment of Cervical Pre-cancer’ from nine Emergency Obstetric and Newborn Care centers are aware of the standardized protocols on colposcopy, LEEP and thermos-coagulation. This ensures the availability of screening follow up services for women and girls in 9 districts and reduces out of pocket expenses related to travel to avail colposcopy and LEEP services. In addition, integration of "hands-on" clinical training during dissemination resulted in the immediate diagnosis and treatment of 20 HPV-positive women via LEEP and colposcopy, directly preventing potential progression to cervical cancer.
   
   
2. Safeguarding Service Continuity
   In response to critical national shortages, the procurement and distribution of 4,500 HPV test kits ensured that screening services remained uninterrupted nationwide.
   
   
3. Strengthening Quality Assurance (QA) and Accountability
   To move beyond training and ensure long-term clinical excellence, the program initiated a robust monitoring and QA framework. In order to achieve this, Clinical audits conducted at Gelephu CRH and Tsirang District Hospital provided the first real-world assessment of adherence to national colposcopy standards. In addition, assessments identified critical areas for 2026 intervention, including the need for standardized image documentation, formalized referral pathways to reduce "loss-to-follow-up," and the certification of Colposcopy Nurses.

Photo : Provided by UNFPA Bhutan Country Office
Photo 1: Sensitization workshop on the Practical guideline on colposcopy and treatment of cervical pre-cancer in Bhutan at Gelephu, Bhutan
Photo 2: Monitoring team lead providing awareness on cervical cancer to staffs of CRRH team while on monitoring and evaluation visit
Photo 3: Dr. Namkha Dorji providing hands-on training to perform LEEP at Bumthang Hospital, Bhutan between 17-19th January 2025
Photo 4: Dr Namkha Dorji, Gynecologic oncologist observing a gynecologist at CRRH, Gelephu performing LEEPsurgery

Reference
*1 Supporting the Project for Eliminating Cervical Cancer Toward the Promotion of UHC in Bhutan ～ Activity Report in 2022 to 2023 ～ (Apr 18, 2024)
*2 Elimination of cervical cancer and related morbidity and mortality in the context of Universal Health Coverage in Bhutan　Report for 2024 (Mar 18, 2025)