Jigmi Wangdi
The Bhutan Health Flagship Project, running from 2020 to 2023, aimed to address the significant health challenges posed by gastric, cervical, and breast cancers, which heavily contribute to the country’s disease burden. The project focused on early detection, prevention, and treatment.
As part of the broader 12th Plan, the initiative addressed areas that were previously underrepresented in the nation’s healthcare services. The project was aimed at reducing the incidence and mortality rates related to these cancers through several key strategies.
For gastric cancer, it involved mass eradication of H. pylori infections, as H. pylori is a known cause of gastric cancer. Screening programmes targeted the population aged between 18 and 75 years, using rapid stool antigen tests or Urea Breath Tests to identify infections.
Those testing positive received triple therapy treatment. Early gastric cancer screening was also conducted for the high-risk group aged between 40 and 75 years, utilising endoscopy services. This comprehensive approach ensured that those identified with gastric cancer received timely and effective treatment.
For cervical cancer, the project integrated highly sensitive HPV tests and liquid-based cytology into the screening process for women between the ages of 30 and 65 years. This method is expected to reduce the rate of unsatisfactory smears and improve early detection rates.
The project also emphasised on enhancing advocacy and awareness programmes to educate the public and health workers about prevention and early detection.
Breast cancer prevention involves screening women between the ages of 40 to 65 years through mammography services and clinical breast examinations. Similar to the strategies for gastric and cervical cancers, the breast cancer initiative also included public awareness campaigns and training for health workers.
According to an official from the Ministry of Health (MoH), significant progress has been made in the mass eradication of H. pylori infections among the target population.
“We have achieved 90.17 percent gastric cancer screening coverage,” the official said, adding that the integration of gastric cancer screening into regular services is helping to meet the project’s targets.
Despite successes, several challenges were encountered. “Encouraging participation in screening programmes has been difficult, even with repeated awareness efforts through various media channels,” the official said.
The pandemic also hindered the implementation of screening programmes, combined with a shortage of human resources.
The official shared that the advocacy and awareness programmes have effectively utilised various media channels and social media platforms.
“The MoH has provided training to health workers on prevention and early detection of gastric, cervical, and breast cancers,” the official said.
However, the official emphasised the need for continual health advocacy and awareness programmes, stressing that a collective effort from all citizens is essential.
In terms of cervical cancer screening, the official said that the coordination between various health facilities had improved. “Those women with positive HPV are followed up and referred to health facilities where services are available.”
Replacing conventional pap smears with HPV tests has significantly reduced the percentage of unsatisfactory smears owing to the higher sensitivity and specificity of HPV tests.
The official added that resource and infrastructure challenges remain a concern, particularly in managing the screening and treatment programmes for these cancers.
“Considering the resource constraints and burden of these three cancers, the screening programme was implemented as a ‘Flagship’ during the 12th Plan. Through this, we have expanded services, bought high-end equipment, and built the capacity of our health workers,” the official said.
Despite a shortage of health workforce, the ministry has been managing with existing resources.
Looking beyond 2023, the ministry has integrated gastric, cervical, and breast cancer screening into regular services and the 13th Plan. This would ensure the sustainability and long-term impact of these initiatives.
“We will continue to provide early detection, diagnostic, and timely treatment in all health facilities above primary health centres,” the official said.
Expansion of palliative care services and enhanced advocacy and education on reducing cancer risk factors will also be implemented. The HPV vaccination programme for eligible boys and girls will continue, along with the use of highly sensitive HPV DNA testing for standard screening.
“Capacity of health workers will be enhanced to deliver quality cervical cancer prevention and control services,” the official added.
The Minister of Health, Lyonpo Tandin Wangchuk, said that the flagship programme achieved 90 percent coverage nationwide through comprehensive screening, stating that the ministry must carry this forward in the 13th Plan to cover the remaining 10 percent.
Lyonpo said that Bhutan’s goal was to eradicate cervical cancer by 2030 and that all efforts were geared towards achieving this goal. The ministry will also prioritise advocacy and awareness campaigns to educate the public about cancer risk factors, such as tobacco and alcohol consumption and maintaining healthy dietary habits