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Systems Strengthening: In conversation with Bhutan’s Ministry of Health

Sanitation and Water for All Secretariat
16 Sep 2019

The water, sanitation and hygiene (WASH) sector in Bhutan has a coordination mechanism (B-WASH Cluster) at the central level to provide a platform for inclusive and participatory collaboration and coordination amongst the various ministries and other development partners. To understand how this initiative is helping Bhutan in Sector Strengthening, we spoke to Chundu Gyem Tamang, Engineer from Department of Public Health, Ministry of Health, Royal Government of Bhutan:


SWA: How could Bhutan's B-WASH cluster program help support systems strengthening– needed for quality, universality and sustainability of WASH services?

Chundu Gyem Tamang: The B-WASH cluster is an annual meeting which is hosted either by the Ministry of Health or the Ministry of Works and Human Settlement. During this 2-day meeting, all the stakeholders involved in WASH are invited. Since WASH in Bhutan is looked after by different agencies, it is important to work in coordination in order to address the WASH issues and avoid duplication of work. When the B-WASH cluster meeting takes place, all the stakeholders are encouraged to present to the forum any problem they are facing so that the group can jointly come up with solutions. At the end of the two-day meeting, the major output is the formulation of resolutions which is always targeted at achieving the national goals. For each resolution, there are lead agencies to take up the primary responsibility and collaborating agencies for supporting the lead agencies. This allows all the stakeholders to share mutual accountability and encourages them to keep in contact with each other throughout the year. The secretariat’s role is to collect information on the progress of the resolutions quarterly and remind the agencies to work on them. With the system of B-WASH cluster, it has become easier for the WASH stakeholders in Bhutan to communicate with each other more frequently and improve the existing coordination and collaboration. This, in turn, has helped Bhutan achieve more progress due to the accountability mechanism in place. The forum has provided the WASH stakeholders with an opportunity to improve the quality of the work they are doing as all the agencies involved support one another to achieve the targets.


SWA: How can strong political leadership drive systems change? Could you please help us with an example from Bhutan?

Chundu Gyem Tamang: After joining service, Bhutan’s current Health Minister has been very proactive and taken initiatives to ensure that the programmes under Ministry of Health set definite targets and formulate proper plans and methods to achieve them. For example, Ministry of Health has a Monthly Coordination Meeting (MCM) chaired by the Honorable Lyonpo (Health Minister) and Health Secretary with the heads of the Departments, Division Chiefs and all programme managers. During the MCM, each programme’s progress in the previous month and planned activities for next month is discussed. The programme managers and heads are also encouraged to present to the forum any challenges they are facing so that it can be addressed. The MCM has made the planning of activities very systematic and it has also made it easier for the programmes to keep track of the APA (Annual Performance Agreement) indicators. The Health Minister also had separate meetings with all the programmes under the Ministry to understand the roles and responsibilities of each programme and see how much progress has been achieved and what more has to be done to fulfill the motive of the programme. This particular meeting provided the programme managers with an opportunity to discuss the prevailing problems and seek the Minster’s support in helping them achieve better results.


SWA: How does SWA's Mutual Accountability Mechanism (MAM) support Bhutan's commitments to SDG6?

Chundu Gyem Tamang: After the adoption of Sustainable Development Agenda in 2015, the absence of baseline data made it difficult to track the SDG2030 target. While the available WASH data were analyzed by WHO/UNICEF Joint Monitoring Programme team, most of the baselines were established except for the safely managed service level. This non-availability of baseline made it difficult for the WASH sectors to set the National Targets in line with the SDG goals. Therefore, commitment to achieve the SDG baseline data was made at forums like the SACOSAN. Since the B-WASH activities are usually aligned with SDGs and SACOSAN declarations, it was also reflected as one of the resolutions in the 3rd B-WASH cluster. The ministry was considered as the lead agency and the development partners as the collaborating agencies. Therefore, the development partners (SNV, UNICEF and WHO) provided the ministry with both financial and technical support to achieve the target. This is a typical example of how the Mutual Accountability Mechanism works in Bhutan. Once the resolutions are agreed upon and signed by the stakeholders during the B-WASH cluster meeting, all the stakeholders involved are mandated to support one another to achieve it. The stakeholders’ authority to fix accountability in the next meeting drives the agencies to fulfil their commitments to SDG6.