During the past 35 years, there have been many achievements in relation to rural sanitation and hygiene in Bhutan. Toilet construction coverage is the highest in the region - 95% of all rural households. Rural water supply has also progressed well with 88% having access to an improved water source. From an institutional point of view, Bhutan has some advantages: the government considers sanitation to be a key factor in achieving Bhutan’s goal of Gross National Happiness, which is enshrined as an individual’s right in the country’s Constitution and has the support of His Majesty the King through the Royal Decree on Sanitation. Implementation is the responsibility of a single ministry, the Ministry of Health, which has received a generous proportion of the total Royal Government of Bhutan (RGoB) budget in successive Five Year Plans. Nonetheless, child morbidity and mortality is still among the highest in South Asia; and water, sanitation and hygiene-related diseases are usually among the top three diseases reported at Basic Health Units throughout the country.
Considering the commendable water and sanitation infrastructure improvement efforts and the integration of health and hygiene education and promotion into the work of the Basic Health Unit staff, Bhutan would appear to be a success story. This paper illustrates that although great progress has been made in community participation, tap and toilet construction coverage, and health education and promotion; more needs to be done to achieve the desired effective use and hygiene behaviour change necessary to ultimately attain the expected health and socio-economic impacts.