WHO Bhutan

Health Information

Water & Sanitation

Overview of External Support to the Water and Sanitation Sectors

Realizing water to be a key element in the socio-economic development process of the country, the third five-year plan (1972-77) saw the gradual emergence of responsible water and sanitation sectors receiving advisory, financial and technological assistance from a number of external agencies.

The rural water supply and sanitation (RWSS) programme began in 1974 with UNICEF cooperation with a view to improving the general quality of life of the people of Bhutan. The UNICEF support to the water supply and sanitation programmes included technical support, financial assistance, non-local supplies and equipment. That year saw the implementation of small and simple gravity-flow supply systems for rural communities and by 1980, a total of 216 such schemes were in place. Two years later, it was estimated that at least 10% of Bhutan's population received the benefits from UNICEF assistance. During that period, Canada, Germany and Australia offered funding support in addition to UNICEF's contribution. In 1982, the Government of Denmark, through DANIDA, agreed to lend support to the RWSS programme until 1988. By 1990, close to 30% of Bhutan's rural population and about 60% of urban population had access to safe drinking water while over 50% of rural and 80% of urban had access to sanitary latrines

Taking a more holistic approach, the European Economic Community started RWSS funding in 1989 in association with UNICEF that was to last until 1994, while the Netherlands Development Organization (SNV) offered significant technical assistance. By then, close to 50% of Bhutan's population had access to safe water supplies with over 1700 schemes implemented, while 70% of the population had access to sanitary latrines. In addition, more than 360 old water schemes were rehabilitated.

Under the EEC /UNICEF funding, a total of more than 4,810 household latrines were constructed, particularly more complicated models of pour-flush type besides the simpler long drop compost and ventilated improved pit. In 1993, the Government withdrew subsidy for latrine construction and made it mandatory for every household to construct its own latrines at own costs. This was largely possible through a Royal Decree issued in 1992, which stressed the importance of having a household latrine and the responsibility to the upkeep, by every household in Bhutan.

Beginning in 1990, activities at improving the environmental hygiene situation of the rural population were given more prominence, realizing that construction of water schemes and sanitation provisions alone did not necessarily affect the health status of the population. The Information, Education and Communication for Health division (IECH) under the Department of Health was assisted by UNICEF in the establishment of Model Villages. Under this funding, health committees of the model villages were supported to take on the development of latrines, separate sheds for cattle, paved footpaths, smokeless stoves or separate kitchens, garbage pits and so forth resulting in a visibly cleaner village environment.

Presently, the Government of Denmark through DANIDA has allocated funds for the rural water supply programmes for a five-year period ending in June 2005. Similar investments by DANIDA are also in place for improvement of urban water supply and sanitation infrastructures besides loan and grant funds from the World Bank and Asian Development Bank. 

Since 1999, the UNICEF has gradually moved away from its initial role as a service delivery facilitator, after 25 years of fruitful cooperation in the rural water supply and sanitation sector. Instead, UNICEF converged its assistance to supporting institutional and capacity building activities in the rural water supply programmes while continuing its commitments to building water and sanitation infrastructure in rural institutions such as schools, basic health units and religious institutions. By 2000, the water supply and sanitation coverages in schools reached 60% and 54% respectively. The coverage in monastic institutions in terms of water supply and sanitary latrines reached 24% and 21% respectively. Besides, UNICEF's own resources, the institutional water supply and sanitation received significant supplementary funds from Japan, Australia, Austria and South Korea since 1999. The overall achievement of the water and sanitation sectors as of 2000 is largely accredited to the coordinated efforts of the UNICEF and its bilateral partners and the commitment placed by the Royal Government in reaching these basic human needs to the grass-root levels.

Sanitation Coverage : Rural & Urban

Rural household sanitation coverage in terms of latrines constructed has accelerated during the last decade, mainly as a result of the royal decree in 1992 that mandated very household to maintain a latrine. It must be mentioned here that a major policy decision was taken by RGoB in 1993 in which subsidies for rural household latrine construction was terminated in view of long term sustainability. This decision ended several years of dual approach of promotion of sanitation activities: improved latrines by PHE then under PWD and simple pit latrines by the health sector. The data post-1994 is primarily that derived from the basic health units and hospitals as compiled in the annual health bulletins.

A tentative water rural sanitation coverage classification is made where the 20 districts of the country are categorised as low (<80% coverage), medium (between 80 to 90% coverage) and high (>90% coverage) sanitation coverage areas based on 2000 coverage data. The variance in  sanitation coverage is indicated in "Map 4" attached. The rural sanitation coverage data of 2000 shown by districts is indicated in Figure 4.4.

Urban sanitation consists mainly of pit latrines, pour-flush latrines with septic tanks or long-drop latrines. The urban centres of Thimphu and Phuntsholing are partially sewered in the core areas and have oxidation ponds for treatment of sewerage with regular monitoring of BOD, COD, dissolved oxygen and suspended matter. For other towns, sewerage systems or low-cost technologies are being investigated by DUDH.

The data compiled for global water and sanitation assessment report 2000 contains estimates (WHO90, JMP93, JMP96, and JMP99) of rural sanitation coverage but arguably are very low figures as compared to those of UNICEF, PHES and the health bulletins. The UNICEF/PHES field offices' best estimate in 1990 was 50% in terms of latrines constructed which is in sharp contrast with 3% as reported in WHO90. Similarly, what went up to 66% by mid-1994 by PHES estimate, the figure reported just 18% by JMP96. Thus the estimation of sanitation coverage here relies on the data of UNICEF, PHES and the health bulletins which are in close agreement with each other.

The urban sanitation coverage reported for 1990 was 80% (WHO90), and by 1994 the coverage dropped to 66% (JMP96) and further down to 65% in 1999 (JMP99). The drop in urban sanitation coverage reflects the rapid growth of urbanization affected by rural to urban migration and the boom in the construction sector. Sanitation statistics reflecting only the registered urban residents show urban sanitation coverage to be up to 90% [1] in 1994 and 88% [2] in 2000. The mean values of the reported urban sanitation coverage are used here and the comparative urban-rural sanitation coverage projection is shown in Figure 4.5. 

4.7       Waste Treatment

Two urban centres of Thimphu and Phuntsholing have sewerage treatment systems covering some 60% and 80% of the households respectively. Both were constructed in 1996 under the DANIDA support to urban development. The households that are not connected to the sewerage system rely on individual septic tanks and the contents are emptied into the main sewerage network through the facilities provided by the city corporations. Otherwise, wastewater treatment is virtually non-existent in the country. It has been planned that some 11 urban centres will have the provision of mobile septic tank cleaning systems. Thimphu has the only solid waste management facility in the country. Solid waste landfills are planned to be developed in 10 urban centres under the World Bank programme and 2 under DANIDA support.

There are two main recipients of effluents and pollution load in the country's waste water management context. The ground absorbs the bulk of the household and small-scale industrial waste water through soak-away septic tanks or mainly direct infiltration from the surface. The main rivers are the final recipients and conveyors of all waste materials. There are no lakes, stagnant bodies or natural wetlands that receive significant effluents creating retention of waste water pollutants.

4.1   The Rural Water Coverage

There is noticeable differences in the annual rural water supply coverage data as reported by the different sources. The differences are naturally anticipated as is explicated by the fact that coverage percentages are expressed either in terms of population or in terms of households, depending on the practice followed by the concerned sectors. Further, data assimilated during the course of reviews of programmes, special studies, and the kinds of sampling routines create variance in resulting data. Without doubt, in all the sources, the biggest upsetting factor for calculating the percentage coverage in years prior to 1994 had been the unsettled demographic data, but noticeable convergence of data is apparent after 1994 when the country's demography was gradually getting validated.

The data for rural water supply coverage from PHES are a result of the survey conducted prior to the implementation of the programme and is primarily a design data necessary to match water demand and supply technicalities. Population counts of the targeted beneficiaries and the projections thereof made to match the system design within an area of focus characterizes their data type. Rural water supply schemes implemented by PHES also cover some urban areas, notably the satellite towns, and as such will have influenced the reliability of the reported rural water supply coverage figures. However, the present day statistics of CSO uses the coverage data reported by PHES as being the best estimate of rural water coverage at the national level.

The basic health units and hospitals around the country also gather and integrate data in preparation for the annual National Health Bulletin. Their statistics are based on counts of households served by piped drinking water. No attempt is made to know whether the piped system is privately installed or installed by PHES or by various other sources. Also too, the number of households served by a particular health unit will not tally with the official records maintained under home ministry regulations. Often enough health statistics will include counts of households that are temporarily settled in that area and who avail the free facilities of the health unit. Examples are camps set up along roadsides for road repair and maintenance and families settled in relation to specific projects upcoming in that area.

The data congregated in preparation for the global water supply and sanitation assessment 2000 report using the WHO/UNICEF questionnaire have been derived through a reconciliation of figures reported by the various above sources. These figures have been scrutinized for ambiguities and updated with recent data, wherever possible, in consultation with the agencies concerned. The rural water supply coverage figures as reported by various sources is shown in Figure 4.1. The figures reported by the Health Bulletins are lower than figures reported by the rural water sector (PHES of the Department of Health which prior to 1998 was PHE under Public Works Department) as because the Health Bulletin data includes populations outside the targeted beneficiaries that are the permanent residents in the locality. Except for the outlier data, JMP93, and the 2000 coverage estimated during JMP99 review, the data of PHE and PHES are those officially quoted by the Central Statistical Organization (CSO) under the Planning Commission.

Figure 4.1 National Rural Drinking Water Supply Coverage (%) (as reported by various sources)

Within a decade, the national average rural water supply coverage had expanded from 30% in 1990 to 78% in 2000 in terms of numbers of households.  The year 2000 [3] coverage represents a total of 2,359 water supply schemes, 987 spring protections and 664 rehabilitated schemes in total serving an estimated rural population of 415,000. The average number of households covered by a rural water supply scheme is around 18, representing an approximate population of 150 heads. Springs provide about 3 households on average whilst old rehabilitated schemes cover an average of about 25 households. Based on the envisaged trend of rural water supply coverage shown in Figure 4.1, the average annual growth during the last decade in terms of implementation of water schemes is about 4 to 5%.

Variations exist in the coverage of rural water supply among the 20 districts ranging from a low of 65% to as high as 98% for the year 2000, as shown in Figure 4.2.  Low coverage is evident in some of the populous districts such as Trashigang, Samdrup Jongkhar, and Sarpang and also in some lesser districts such as Gasa, Zhemgang and Dagana that are characterized by remote and highly dispersed populations. The case of Thimphu and Paro in the low coverage class probably reflects sub-urban migrant settlers from other parts of the country that have not been accounted by rural water schemes of PHES but may very well have their own water supply schemes.

A tentative water supply coverage classification is made as given in Table 4.1 where the 20 districts of the country are categorised as low, medium and high water supply coverage areas based on 2000 coverage data. The tentative classification has been made for the purpose of projecting the variance of the water coverage in "Map 3" attached. The distribution of population by districts is also provided in the table in accordance with the water supply classification. Higher populations exist in areas where the water supply coverage is low and this may be accredited to the remote and dispersed nature of populations in those districts. On the contrary, the high water supply coverage districts are characteristic of low population densities with at least 6 out of 7 districts with population distribution under 5% (the mean district % population of the country). The highest water supply coverages in the districts of Bumthang and Haa have had the added advantage of having more clustered villages in relation to other districts.

Table 4.1                 Percentage District [4] population, 2000 by Rural Water Coverage Classification

4.3       Urban Water Supply Coverage

The data of WHO / UNICEF in the preparation for the global water supply and sanitation assessment 2000 report provides as assessment of urban drinking water supply coverage as shown in Figure 4.3.  The coverage data was largely drawn through the DUDH but the figures are not representative of all 54 settlements designated as 'urban' in the country. Data for the year 2000 represents coverage of urban water supply for 28 towns only. The lesser 26 satellite towns are covered within the RWSS programmes. The coverage data is affected by the fact that the pace of urbanization is increasing rapidly due to a growing tide of migrants from rural areas. It has been estimated that by around 2020 close to half of the population will be living in urban areas.

The annual coverage of urban water supply based on a best-fit linear plot of the existing data indicates coverage growth rate of about 2% annually. The projected annual percentage urban water supply coverage from 1990 to 2000 is provided in table 4.2 below.

Arsenic Tests

Arsenic has been a major concern for people in neighbouring India, and Bangladesh where the groundwater water sources have been detected with considerable amounts of arsenic with values above risk-free limits. Although arsenic poisoning has not been reported in Bhutan, precautionary tests were carried out between March and April, 2001, by PHES/PHL [5] with the support of UNICEF in a few selected areas, notably in the southern belt, where some of the drinking water is drawn through groundwater and sub-surface (infiltration) sources. The results of all the sampled tests indicated that arsenic is not a major risk at the moment. The present plans include the setting up of a regular arsenic and heavy metal monitoring unit under the auspices of the Bhutan Water Partnership  in collaboration with all the consumptive water user agencies in the country.

2.3.1    Water Quantity

Surface Water

An ongoing study on water resources management plan [6] (WRMP) splits the country into three main basins having characteristic north-south zones that typify different water utilisation strategies and potentials for development. The north-south rivers are the larger rivers running from the highest mountains of the country down to the lowlands near the Indian border. Due to the location of the headwaters, melting snow and glacier melt contributes to the flow in these rivers. The second main category of rivers, designated as the east-west tributaries, include all the minor streams that flow as tributaries into the north-south rivers. These minor streams are mainly rain-fed. In relation to water supplies to both rural and urban, the east-west tributaries are of importance.

Good records of flow have been obtained for over a decade for the north-south rivers from some 20 principal flow-gauging stations spread at suitable locations throughout the basins. Flow records are further supplemented by 12 gauging stations from different east-west tributaries and through spot measurements for lesser streams conducted annually during the lean season. Basic flow information in terms of mean annual runoff and specific minimum runoff over complete upstream catchment areas for both north-south and east-west rivers have been developed for the entire country and the data are available with the Hydrology unit of the Department of Power. The minimum specific runoffs for east-west tributaries are of interest to water supply and sanitation planning and ranges from a minimum of 4.2 l/s/km2 to as high as 14 l/s/km2 depending on the location.

Groundwater

A common type of landscape in Bhutan is the gently sloped farmlands formed by landslide material. Farmers living in such areas depend on springs emerging from these landslides for their domestic use. These springs can yield as much as 10 litres of water per minute. The recharge amount has been estimated at around 400 mm/year, 200 each from precipitation and from fractures (JICA,1996). Springs emerging from basement rocks are ubiquitous in mountain regions but here in the Bhutan the potential of such has not been surveyed. Areas in the foothills promise exploitable groundwater as these areas are formed from fluvial deposits in connection with present and ancient riverbeds. Groundwater in mudflow and alluvial deposits has been estimated at an exploitable rate of 3 litres/second/km2. Groundwater wells and infiltration facilities exist in a few places in Bhutan. The southern belt of the country bears good scope for groundwater utilization as a source of drinking water.

2.3.2    Water Quality

Systematic water quality monitoring activities are new to Bhutan. Seen in global perspective, Bhutan is wholly a headwater country. Some advances have been made in water quality monitoring over the last few years, with the first initiative by the National Environment Commission (NEC) in the form of a National Baseline Water Quality Survey (NBWQS) in 1997. The survey report analysed dissolved oxygen, salinity, temperature, pH and conductivity. The PHES has also monitored some 83 samples of water from water supply sources throughout the country. However, the analytical results of these samples are not considered by PHES to be reliable enough to be included in a national database. To bring the sector interests in water quality in tune with international requirements and NEC's monitoring network, PHES has embarked on collecting water quality data from their schemes in three districts (Gasa, Thimphu and Chukha) with the intention of building up their database gradually.

The WRMP project has collected samples from around the country. The main-stem rivers have been sampled from as high up and as far downstream as practically possible and the analysis reports provide values for the following parameters: pH, conductivity, phosphorous, ammonia, calcium, magnesium, potassium, zinc and manganese.

From available data on NBWQS and the conclusion supported by assessment by WRMP, it is clear that Bhutan's rivers are highly oxygenated and consistently slightly alkaline with low conductivity and no recorded salinity. Except for BOD / COD testing being carried out in sewage treatments of two urban towns of Thimphu and Phuntsholing, there is no information regarding the state of toxic pollution of water by heavy metals, pesticides, herbicides, industrial waste products, etc. Recent testing of wells in the south confirmed the non-existence of arsenic [7] that was feared from studying similar conditions in the neighbouring countries.

Population

National population censuses were undertaken in Bhutan in 1969 and 1980. The population figures in those years were large because of large migrant population from neighbouring countries. The 1994 national health survey based on which the population figures have been officially amended assesses the average population growth rate close to 3.1%. Until the next round of census scheduled for 2005, the estimate of population provided below stands as the most current official figure.

The estimated population [8] of Bhutan in 2001 was 698,950, with a male: female ratio of 1:0.98. The population under 15 was 42.1% and that over 65 was 4.3%. Population estimates for the year 2001 by age and sex are segregated in the pyramid shown in Figure 2.3. The pyramid is typical of an developing nation.

The child dependency and old age dependency ratios stood at 78.5% and 8% respectively. The distribution of urban [9] and rural population has been estimated at 21% and 79% respectively.

[1] Source: Statistical Yearbook of Bhutan - 2001, Central Statistical Organization, Planning Commission, RGoB. Note: The estimate is based on population growth rate of 3.1% over NHS, 1994

[1] Source: 9FYP Background Paper, Department of Urban Development and Housing, Ministry of Communications.

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[1] Source: Bhutan Water Supply & Sanitation Sector Master Plan, WHO/SEARO, SEA/EH/520, 1999.

[2] Source: Ninth Plan Main Document (2002-2007), Planning Commission, RGoB.

[3] Source: Rural water and Sanitation Sector Policy; Background Information Document, June 2001, PHES

[4] Source: National Health Survey, 2000.

[5] Report of Arsenic Detection Tests, Phase I and II, March - April, 2001. PHES / PHL / UNICEF.  

[6] Source: Main Volume, Baseline Study Report, Water Resources Management Plan & Update of Power System Master Plan, Department of Power.

[7] Report of Arsenic Detection Test, Phase 1 & 2, PHES/ UNICEF, April 2001.

[8] Source: Statistical Yearbook of Bhutan - 2001, Central Statistical Organization, Planning Commission, RGoB.  Note: The estimate is based on population growth rate of 3.1% over NHS, 1994.  

[9] Source: 9FYP Background Paper, Department of Urban Development and Housing, Ministry of Communications.