Systems change in Bhutan: Enabling healthier lives through sanitation and hygiene improvements


Since 2010, the Government of Bhutan has been growing the scope and scale of its Rural Sanitation and Hygiene Programme (RSAHP). From the country’s high and steep mountains to its deep low valleys, the government’s vision is for all of Bhutan to have access to improved sanitation facilities by 2022. With four more districts to go, the anticipated success of Bhutan adds to the body of undisputed evidence behind the importance of political will, sufficient resources, and long-term partnerships and collaboration to achieve systems change – the kind that facilitates the dignified life of all people and ensures that every person may engage in various forms of social and economic life. 

SNV has been working in Bhutan since 1988. On its 20th year in Bhutan, SNV launched its first integrated approach to sanitation and hygiene in the country, the Sustainable Sanitation and Hygiene for All (SSH4A) approach. What started as a pilot project in 2008 evolved into the government’s sanitation and hygiene approach of choice. Take a trip down ‘memory lane’ and read SNV in Bhutan’s 6-page systems change case study, which documents the beginnings of the country’s integrated sanitation and hygiene programme, and key government-led achievements realised so far.  

Over the years, this approach expanded horizontally, in geographical reach (villages, districts, and countries) [1] and vertically, by embedding further the SSH4A approach in various levels of Bhutan’s governance processes. It contributed to the emergence of a WASH sector in Bhutan, in close cooperation with UNICEF. And, parallel to these developments, the SSH4A approach scope grew (from the eradication of open defecation practice to professionalising sanitation and hygiene services). [2] 

For many of us who work in development, we all know that our systems are enmeshed in constructs of power and privilege. This is why we need to be creative. This is why we need to keep questioning our ideas as these could potentially harm and reinforce structures and systems of exclusion and oppression.

Therefore, facilitating everybody’s access to improved sanitation facilities does not only mean the construction of facilities. It also means:


Since 2010 the Australian government has been supporting SNV's continuous engagement with the Government of Bhutan. [3] In Bhutan, the trust and confidence of local and national government, (I)NGOs, and other development actors on SNV have been key in enabling the continuation of a meaningful partnership in development. 

As we approach the end of this extremely trying year, we want to draw attention to stories that show positive and sustainable impact. Through these stories, we hope that we are able to offer some perspective that no matter the challenges faced by humanity, a human rights-based approach to development complemented by broad-based partnership always wins.


[1] SNV’s SSH4A approach, which was first piloted in Bhutan, has been applied to 18 more countries in Africa and Asia. With the number of countries still growing, during the first half of 2020, SNV concluded its highly successful multi-country programme, which changed the sanitation and hygiene lives of millions of people; i.e., 4.2M people with access to improved sanitation, and close to 2M people with access to a handwashing with soap facility. Read more.
[2] Interested to learn more about SNV’s rural sanitation and hygiene approach? Access SSH4A capability statement here
[3] For this cycle of cooperation, SNV's work in Bhutan is financed by the Australian Government through its Water for Women Fund. Learn more about the Fund here.

Prepared by: Anjani Abella, WASH Marketing Communications Advisor, SNV

Photo: Everybody, together, for improved sanitation and hygiene in Bhutan by end 2022; taken in 2019 (SNV/Aidan Dockery)

For more information, contact: Gabrielle Halcrow (Multi-country Programme Manager of the Beyond the Finish Line Programme financed by the Australian government) or Kencho Wangdi (WASH Sector Leader, SNV in Bhutan)


Kencho Wangdi

WASH Sector Leader - Bhutan