Bhutan CPE of 5th CP (2008-2013) PDF

DESK REVIEW I UNFPA 5th COUNTRY PROGRAMME 1
DESK REVIEW
UNFPA FIFTH COUNTRY PROGRAMME ASSISTANCE
(2008–2013)
UNFPA Bhutan Country Office, May 2012

Submitted to
UNFPA Bhutan Country Office
By
Richard H. Columbia, PhD
Hemant Dwivedi, MD
Tharanga Godallage, MA
ACKNOWLEDGEMENTS
The review team wishes to thank and acknowledge the Royal Government of Bhutan particularly the
Gross National Happiness Commission, UN agencies, and UNFPA Bhutan Country Office for
participating in the review process.
Recognition is extended to the UNFPA Assistant Representative, Mr. Yeshey Dorji and two Programme
Officers, Ms. Karma Tshering and Ms. Dechen Chime for providing invaluable information and ideas
that shaped the review process, finding and recommendations.
Contents
List of abbreviations and acronyms 06
Executive summary 08
1.0 Introduction 10
1.1 Background 10
1.2 Desk review purpose and objectives 14
1.2.1 Desk Review scope 14
1.3 Desk Review methodology 14
1.3.1 Data collection methods 14
1.3.2 Desk Review Team 15
1.3.3 Stakeholder participation 15
1.3.4 Ethical consideration 15
1.3.5 Challenges and limitations to desk review 15
1.3.6 Structure of the report 16
2.0 Desk review findings 16
2.1 Reproductive health 16
2.1.1 Context 17
2.1.2 Programme management and partnerships 17
2.1.3 Relevance 18
2.1.4 Effectiveness 20
2.1.5 Efficiency 21
2.1.6 Sustainability 21
2.1.7 Impact 22
2.1.8 Facilitating factors 22
2.1.9 Hindering factors 22
2.1.10 Key future CP opportunities 22
2.1.11 Conclusion 23
2.1.12 Recommendation 23
2.2 Population and development 24

2.2.1 Context 24
2.2.3 Relevance 25
2.2.5 Efficiency 28
2.2.11 Recommendations 29
2.3 Gender 30
2.3.1 Context 30

2.3.3 Relevance 32
2.3.5 Efficiency 35
2.3.7 Impact 37
2.3.12 Recommendations 38
3.0 Country Programme recommendations 39
4.0 Desk review utilization 39
Appendices 40
1 Terms of Reference
2 List of persons interviewed
3 List of documents reviewed
4 General observations and suggested items foe country office consideration
RH1: UNFPA CPD results and resource framework 2008
PD1: UNFPA CPD PD resources results framework
PD2: UNDAF CCPAP: UNDAF cCPAP and UNFPA-related PD
PD3: UNDAF Mid Term Review: CT Outcome Rating from MTR Evaluations and Self-Assessments
5 11th Five Year Plan (in-draft and as reference only)
List of abbreviations and acronyms
AIDS Acquired immunodeficiency Syndrome

ANC Ante Natal Care
BCC Behaviour Change Communication
BHU Basic Health Unit
BNF Bhutan Nun’s Foundation
CCA Common Country Assessment
cCPAP Common Country Programme Action Plan
CP Country programme
CPAP Country Programme Action Plan
CPD Country Programme Document
CSO Civil Society organization
DANIDA Danish International Development Assistance
DaO Delivering as One
DH District Hospital
DP Development Partner
DYS Department of Youth and Sports
DRA Drug Regulatory Authority
DVED Drug Vaccine and Equipment Division
EmONC Emergency Obstetric and Neonatal Care
FYP Five Year Plan
GBV Gender-based Violence
GNH Gross National Happiness
GNHC Gross National Happiness Commission
GIS Geographic Information System
GPS Geographic Position System
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HR Human Resource
IP Implementing Partner
ICPD International Conference on Population and Development
JDWNRH Jigme Dorji Wangchuck National Referral Hospital
JRT Joint Review Team
MDGs Millennium Development Goals
MOE Ministry of Education
MOF Ministry of Finance
MSTF Multi Stakeholder Task Force
M&E Monitoring and Evaluation
NCD Non Communicable Diseases
NCWC National Commission on Women and Children

NFE Non Formal Education
NGO Non-Governmental Organization
NHP National Health policy
NRH National Referral Hospital
NSB National Statistical Bureau
OPD Out Patient Department
PLWHA People Living With HIV AIDS
PHCB Population and Housing Census of Bhutan
RENEW Respect, Educate, Nurture and Empower Women
RGoB Royal Government of Bhutan
RIHS Royal Institute of Health Services
RUB Royal University of Bhutan
ROs Religious Organizations
SDG SAARC Development Goals
SoPs Standard operating Procedures
SAARC South Asian Association for Regional Cooperation
STI Sexually Transmitted Infections
SRH Sexual and Reproductive Health
TFR Total Fertility Rate
UNDAF United Nations Development Assistance Framework
WISN WHO Workload Indicator of Staffing Need
Executive summary
The purpose of this desk review was to assess the achievements of the United Nations Population Fund
(UNFPA) 5th Country Programme (CP) (2008-2013), the factors that facilitate or hinder achievement, and to
compile lessons learned in respect of each of the programme stages to inform development of the 6thCP in
line with UNDAF, Royal Government of Bhutan (RGoB) 11th Five Year Plan (11th FYP) and UNFPA revised
strategic focus. This also supplements the end of project evaluation required by the board for development
of 6th CP.
Methodology
Data collection was mainly depended on the secondary data sources. The review team conducted a desk
review of documents at both global and country levels. In addition, the review team conducted a series of in-
depth interviews and group discussions, where appropriate, with selected key informants and stakeholders.
The desk review team comprised of three UNFPA staff; M&E Advisor of Asia Pacific Region Richard
Columbia, PhD , State Programme Officer of UNFPA, Orissa sub office in India Hemant Dwivedi, MD,
Monitoring and Evaluation Officer of UNFPA Sri Lanka country office Tharanga Godallage, MA.
Challenges/Limitations
The Desk Review Team was confronted with a series of challenges, including the thematic assessments
commissioned by the United Nations Country Team (UNCT) did not examine the contribution of participating
agencies separately, but the United Nations (UN) as a whole. Furthermore the United Nations Development
Assistance Framework (UNDAF) capacity development assessment was not completed in time for this desk
review. This would have been an importance source of information for the desk review given UNFPA
emphasis on capacity building.
UNFPA Bhutan fifth country programme
UNFPA’s 5th CP commenced in 2008 and was anticipated to conclude in December 2012. However, the 5th CP
was extended to December 2013, to align with the agreed one year extension of UNDAF cycle. The overall
programme was expected to contribute to the two outcomes in the two programmatic focus areas, namely,
reproductive health and population and development. Gender was considered a cross cutting area
throughout the programme. UN Bhutan became a Delivery as One (DaO) self-starter aiming at delivering UN
development assistance in a more coordinated and effective manner. Hence UNFPA 5th CP was
operationalized through Common Country Programme Action Plan (cCPAP) under the UNDAF.
Findings and conclusion
The RH programme made significant progress and contributed to national priorities as well as the UNDAF
(2008-12). The RH programme strengthened provision of services for maternal health, family planning,
cervical cancer and contribute in the life skills education (LSE) based sexual and reproductive health (SRH)
integration process. The programme efforts contributed into development of National reproductive health
(RH) strategy to improve access and quality of SRH services. UNFPA could continue reinforce its leadership in
SRH through focused strategic and catalytic support for strengthening systems, promoting community
participation.
Under the Population and Development component, UNFPA was successful in achieving the intended results
and was aligned to the national priorities, UNDAF outcomes, and the UNFPA strategic plan. The selection of
implementing partners was found to be appropriate. Under output 1 UNFPA contributed successfully in
capacity development of the National Statistics Bureau (NSB) and Gross National Happiness Commission
(GNHC) including the demand for development of the National Population Policy, and Population Perspective
Plan. Under output 2 UNFPA contributed to the successful establishment of the double subject degree course
at college.
Under Gender component, UNFPA was successful in achieving the intended results and was aligned to
national priorities, UNDAF outcomes, and the UNFPA strategic plan. For gender component, UNFPA had
selected correct Implementing Partners (IPs) to achieve intended results and contributed successfully in
capacity development of them.
Under the overall observation, the Country Office (CO) needs to focus on strengthening the linkages between
CP outcomes and output inventions, and monitoring and evaluation framework to the outputs of
UNDAF/cCPAP outcomes and output interventios.
Key future CP opportunities
At the request of senior management and programme the Desk Review Team added a section to the report
to explore opportunities for the next CP cycle based on gaps in the existing programme or emerging needs.
Prioritized recommendations
The prioritized recommendations under reproductive health are: 1) continue the CP current support LSE and
Youth Friendly Services (YFS). While the CO current level of support to LSE appeared adequate, support to
YFS needs to be strengthened and intensified; 2) continue focused and strategic support for family planning
and purchasing of family planning methods including supporting the RGoB achieve 100% self-sufficiency in
purchasing FP methods during the next programme cycle; and 3) continue CP focus on to strengthening
interventions for safe motherhood, RH morbidities like cervical cancer and midwifery training institutes.
Strengthening Health Information and management system also needs to be included here.
The prioritized recommendations under population and development are: 1) support Sherubtse College
expand its double degree initiative to population and sociology, including gender perspective; and 2) UNFPA
should support design, implementation, analysis (post census thematic analysis) and dissemination of the
2015 Census.
The prioritized recommendation under gender is to focus the CP gender efforts on building the national
capacity in the health sector’s response to GBV. Strengthen the health sector’s response as part of multi-
sectoral approach to integrate GBV as public health issue in health system and programs through capacity
building of health care providers, developing protocols and guidelines and develop MIS.
The prioritized recommendations for the CP is to strengthen the country office and IPs capacity in results-
based management, evidence based programming and develop a robust monitoring and evaluation system.
1.0 Introduction
1.1 Background
Bhutan is one of the Asia’s smallest nations, located in the eastern Himalayas and shares its borders with
China to the north and Indian to the west and south. Bhutan’s land area is approximately 38,394 sq km and is
mostly mountainous with more than 64% of the landmass covered by forests and 8% being cultivated
permanently or used for human habitation.
Bhutan’s total population was 672,425 in 2005 and is projected to grow to around 890,000 in 2030, an
increase of 40% within the next 25 years. Within the same period the number of persons living per square
kilometer will steadily increase from 16 persons to an estimated 23 persons; birth rate is expected to decline
from an estimated 26.1 to 14.5. The overall sex ratio in 2005 was 111 and the life expectancy rate at birth in
2005 was 66 years for males and 67 years for females with an expected increase to 74 years for males and 75
years for females in 2030. Approximately one third of the Bhutanese population is below 15 years of age with
more than 56% of the population below 24 years of age while a little less than 5 percent is older than 64
years.
Bhutan has a constitutional monarchical form of government since 2008 and the nation is governed primarily
through the Cabinet. The country is administratively divided into 20 Dzongkhags (districts) and further
divided into 205 Gewogs (blocks), each headed by a district governor (dzongda) who is nominated by the
government. The highest level of legislative body at the district level is Dzongkhag Yargye Tshogchung (DYT)
and at the block level is Gewog Yargye Tshogchung (GYT) where the local governing body functions are
decentralized administratively and financially.
The National literacy rate had significantly increased from just 14.2% in 1980 to 59.5% in 2007. Bhutan has
made progress towards the realization of the MDGs; achieving universal primary education and ensuring
gender equality in education. The primary net enrolment rate was 93.7% in 2009 and the ratio of girls to boys
in primary school was 99.4%. Bhutan has a policy of free education till tertiary level including providing
vocational training and education for children with special needs.
Bhutan has maintained a system of free basic health care not only for Bhutanese but also for those who
reside in the country. Access to free basic health care is also enshrined in Section 21 and 22 under Article 9 of
the Constitution of the Kingdom of Bhutan. The primary health care approach includes integrated preventive,
promotive and curative care services, which have reached to more than 90% of the population. Indigenous
medicine is seen as a complementary part of the overall health services. Within a span of four decades the
nation’s health system has made remarkable progress. Life expectancy was estimated at 66 years in 2000. The
infant mortality rate fell from 70.7 per 1,000 live births in 1994 to 40.1 in 2005.Maternal mortality declined from
770 per 100,000 live births in 1984 to 255 in 2000.
Picture 1: Administrative map of Bhutan
UNFPA fifth country programme in Bhutan
In support of the country’s development in the 10FYP, 15 UN agencies operating in Bhutan had mutually
agreed with the RGoB to develop a cCPAP under the umbrella of DaO. To enable formulation of the 10FYP
and the UNDAF 2008-2012 with subsequent extension to 2013, the RGoB and UN had jointly carried out a
Common Country Assessment (CCA), assessing the development situation of the country and serving as the
basis for preparation of UNDAF. Based on the findings of 2006 CCA, UNFPA 5thCPD was developed in line with
UNDAF.
UNFPA’s 5th CP commenced in 2008 and was anticipated to conclude in December 2012. However, 5th CP was
extended to December 2013, in line with the agreed one year extension to the UNDAF. The overall
programme was expected to be results oriented with the emphasis on national capacity building especially in
the delivery of high quality, equitable, inclusive and sustainable services for two programmatic areas of
reproductive health and population and development. Gender was a cross cutting issue.
The programme is mostly funded through UNFPA regular resources and implementation has two modalities,
which are UNFPA execution and national execution. The 5th CP has a total budget of USD 5 million for the five
year cycle. However, the actual resource allocations have changed over time, based on the resource
availability and programmatic needs as shown below. The UNFPA resource allocation system has classified
Bhutan as a group “A” country.
Table 1: CP 5 budget 2008_2011 (Regular and other sources)

Source of Fund Planned Budget ($) Expenditure ($) Implementation rate (%)
UNFPA Regular 4,849,198 4,396,660 91
Multi-donor Trust Fund 223,729 225,823 100
Human Security Trust Fund 81,053 81,053 100
Emergency Fund 156,795 156,794 100
Total 5,310,775 4,860,330 91
Diagram 1: Country programme structure

1.2 Desk Review purpose and objectives
The purpose of this desk review was to assess the achievements of the 5th CP, the factors that facilitate or
hinder achievement, and to compile lessons learned in respect of each of the programme areas to inform
development of the next country programme cycle (CP 6) in line with UNDAF, RGoB 11th FYP and UNFPA
strategic plan. The Desk Review is also meant to satisfy the UNFPA requirement for end of programme
evaluation summary report under the condition of participating in a Joint UNDAF evaluation.
As expressed in the TOR, main objectives of the 5thCP desk review were to:
 Assess and document the extent to which the 5th CP has achieved its outputs and contributed to its
intended outcomes including ICPD programme of action, MDGs and other national priorities
 Document lessons learned, challenges and best practices
 Formulate recommendations that can be applied to the next CP strategies in line with 11FYP, UNDAF
and UNFPA strategic plan
1.2.1 Desk review scope
The scope of the desk review was the UNFPA support to Bhutan, covering the 5th CPD and respective cCPAP
for the period 2008-2011. The Desk Review covers the UNFPA assistance financed by regular and other
resources.
1.3 Desk review methodology
1.3.1 Data collection methods
As mentioned in the TOR data collection was mainly dependent on the secondary sources. A desk review
methodology framework was developed to address the desk review questions outlined in the TORs, based on
the desk review criteria. The desk review methodology framework expands upon the TOR questions (Annex
1), and thus provides a wider interpretation of the issues. The Review Team decided to present findings
sorted by the five DAC because of its compatibility with the collection and presentation of findings from
United Nations supported evaluation in general and the Bhutan Joint UNDAF Thematic Reviews and
Assessments specifically.
The review team conducted a desk review of documents at both global and country levels. Global
documentation included UNFPA global policy documents and ICPD documents. Country level documents
were drawn from a number of sources, including the thematic reviews commission by the UNCT, government
of Bhutan, UNFPA, other multilateral and bilateral agencies and NGOs working in Bhutan. Documents
included UNDAF document, UNDAF mid-term review report, CCA report, cCPAP, annual workplans, country
programme documents, reports of annual programme review meetings, national surveys, national reviews,
annual and quarterly progress reports, consultancy reports, monitoring visit reports, etc. A list of references
and documents reviewed is included as Annex 3.
The Review team conducted a series of in-depth interviews and group discussions, where appropriate, with
selected key informants and stakeholders. The key informant interviews and group discussions elicited
stakeholder opinions on the relevance, effectiveness, efficiency, sustainability and impact. A full list of people
interviewed and group discussions held is included as Annex 2.
Data triangulation was achieved by interviewing a range of stakeholders at different levels from a variety of
institutions, and reviewing a wide range of documents.
1.3.2 Desk review team
The Desk Review Team comprised of three UNFPA staff; M&E Advisor of Asia Pacific Region, State
Programme Coordinator of UNFPA India Country Office, Monitoring and Evaluation Officer of UNFPA Sri
Lanka country office. The entire report benefitted by the comments and feedback received from the country
office staff and the team members, stakeholders, and UNFPA APRO.
1.3.3 Stakeholder participation
UNFPA Bhutan’s stakeholders were provided with opportunities to participate meaningfully in the Desk
Review process. Government counterparts and key stakeholders were involved during the Desk Review
process. There was an initial meeting with GNHC to brief on the Desk Review process and get their
comments.
UNFPA country office was involved throughout the process. During the data collection stage all the
implementing partners were interviewed and Desk Review Team could get their valuable comments for the
Final Report. The Desk Review Team provided a debriefing to the UNFPA country office on preliminary
recommendations of the Final Report. Following the submission of the draft report by the Desk Review Team,
UNFPA CO and UNFPA APRO were given the opportunity to provide feedback and comments, and this
feedback was incorporated into the revised report.
The final day of the Mission was spent with the CO team and UN Resident Coordinator to discuss and refine
the set of recommendation to improve their focus, scope, ownership, and usefulness.
1.3.4 Ethical consideration
The Desk Review Team strived to: (a) ensure that respondents understood the purpose, objectives, and the
intended use of findings review; (b) be sensitive to cultural norms and gender roles during interactions with
all respondents; and, (c) respect their rights and welfare by ensuring informed consent and rights to
confidentiality before interviews.
1.3.5 Challenges and limitations to the desk review
It is acknowledged that the robustness of the Desk Review design is compromised by: the limitations of
counterfactuals, constraints in identifying sound bases for comparison, and possible biases of key
stakeholders. The Desk Review sought to mitigate these limitations and minimize possible biases through
triangulation of methods and data, when feasible. The time allocated to this desk review was 25 days split
among the three Desk Review Team members and therefore, by definition, the desk review could not be in-
depth and cover every aspect of the programme over the programme period.
Further the team was confronted with a series of other challenges including: 1) the thematic assessments
commissioned by the UNCT did not examine the contribution of participating agencies separately, but the UN
as a whole. Further the UNDAF capacity development assessment was ongoing at the time of this desk
review. This would have been an importance source of information for the desk review given UNFPA
emphasis on capacity building; 2) lack of baseline and endline data for most of the indicators at output and
outcome levels; 3) limited availability of monitoring data and evaluations at programme and intervention
levels; and 4) reports are often rather descriptive with limited reflection on results.
The review team did not verify the financial figures in this report. All financial figures where provided by the
CO.
1.3.6 Structure of the report
The report provides the context within which the country programme operates. With a general discussion on
the programme design, programme management and partnership assessment that are common to the
overall country programme, the report discusses the findings under each programme component, namely
Reproductive Health, Population and Development and Gender. The strategies employed to achieve the
results were assessed and grouped using DAC criteria – relevance, effectiveness, efficiency, sustainability and
impact when possible.
Although country programme consists of two programme components (Reproductive Health and Population
and data) the team decided to report gender as a separate section since the three programme components
have specific characteristics and based on TOR. Each component will discuss separately, the facilitating and
hindering factors in achieving results, and program design issues and management issues that are relevant to
that particular component.
A subsection was added to the report under each thematic area to highlight opportunities for the next
UNDAF and CP cycle based on gaps in the existing programme or emerging needs. This section was included
to support the CO prepare for the next by raising issues found in the literature but that were outside the
structure of current CP and therefore potentially overlooked in this report.
2.0 Desk review findings
2.1 Reproductive Health
2.1.1 Context
As per UN estimates of 2010, the MMR of Bhutan reduced from 940 per 100,000 live birth in 1990 to 180 per
100,000 live birth in 2010 with 8.2 percent reduction per annum against global average of 2.3 percent . The
total fertility rate (TFR) reduced from 5.6 in 1994 to 2.6 in 20051 . By 2010 the national IMR decreased to 47
per1000 live birth and U5MR rate to 69 per1000 live birth from 1990 baseline of infant mortality rate (IMR)
91 and under five mortality rate (U5MR) 1482. The skilled birth attendant (SBA) has increased with the BMIS
2010 reporting at 64.5 percent, up from 24 percent in the year 20003 . The adolescent (15-19 years) birth rate
of 46 contributes to 11 percent of the total birth in the country. It is estimated that by 2020 the urban
population will reach a mark of 60 percent level. About 88 percent of total health expenditure in the country
is through public financing, where public health system provides free basic health care to all citizen of the
nation. The rugged terrain, dispersed population agglomeration, with low female literacy (34%) and high
poverty level of 23.2 percent (2007) remains concern for access to services for spatial population. Sustained
progress at national level towards the MDGs however tend to mask significant disparities and achieving the
MDGs with equity remains a core issue and challenge to health system of Bhutan.
1
MMEIG estimates for 2008 and PHCB 2005
2
BMIS 2010 data on U5MR-reference period 2006
3
RGoB and UNDP 2000-Bhutan;s progress- Midway to MDGs, November 2008
th
Table 2: UNFPA CP RH allocation and expenditure for RH programming during the 5 CPD
Year Budget ($) Expenditures ($) Implementation Rate (%)
2008 509,600 477,205 94
2009 388,831 381,895 98
2010 692,227 621,070 89
2011 688,054 632,243 91
Total 2,278,712 2,112,412 93
During reference period 2008-11 of CP5 overall 92.5 percent of committed financial resources were utilized for RH
Component, which is almost equal to overall fund utilization (91.5 %) of CP 5 until December 2011.
The RH component of CP 5 has two outcomes. The outcome 1 has four outputs out of which output 3-
Improved capacity of institutions and health service providers to respond to GBV has been discussed under
thematic area of gender in this report. The outcome 2 of RH component has one output. The RH component
contributes to the national health sector program being implemented under 10thFYP and to the UNDAF
outcome 2 of health sector and UNDAF outcome 3 of education sector. The CP5 is being implemented
through Common Country Program Action Plan (cCPAP) of UNDAF 2008-12/13 under the umbrella of DaO.
2.1.2 Program management and partnerships
UNFPA collaborated with UNICEF, WHO, World Bank and UNDP for implementation of RH component under
UNDAF. The major implementing partners of RH components are – Ministry of Health (Reproductive Health
Program, Planning and Policy Division and Drugs Vaccine and Equipment Division), Royal Institute of Health
Sciences (RIHS) of Royal University of Bhutan(RUB), Community Health Unit of JDWNRH for outcome 1.
Whereas, Department of Youth and Sports (DYS) under Ministry of Education and College of Education of
RUB were major implementing partners for outcome 2. Recently, partnership with LHAKSAM for output
pertaining to HIV/AIDS under outcome 1 has been initiated. The Gross National Happiness Commission,
department of Public Account under Ministry of Finance are partners engaged in facilitating coordination of
planned activities and fund flow through national budget framework of UNFPA resources to the
implementing partners.
2.1.3 Relevance
The common country Assessment (CCA) 2006 reflecting national priorities pertinent to RH component,
UNFPA’s global Strategic Plan (2008-11) and Strategic Directions of UNDAF program (2008-12) have been
referred to assess alignment of CP5 with national priorities, policies, ICPD -PoA and MDG 5 (A&B).
The programmatic directions indicated by CCA 2006 for UNFPA’s CP5 were to support skills enhancement and
access to SBA, reaching communities to enhance understanding for danger signs, birth preparedness and
complication readiness, and promote active management of third stages of labor, promote infection
prevention practices for institutional and home deliveries. The need existed to enhance access to appropriate
information for promoting informed choices for fertility management particularly among young couples and
young girls to empower them to negotiate use of contraceptives, promote and support condom
programming for safe sex practices including prevention from HIV/AIDS. The need to reach in and out of
school adolescent with socially acceptable and culturally appropriate information and services on SRH
through Life Skills education was also identified as programming priority. For systems strengthening
dimension strengthening HMIS and promote data led decision making in health sector was of importance to
UNFPA’s work under CP5. The desk review found a considerable degree of alignment of CP5 with national
priorities. The strengthening of HMIS for improved use of data in program management remained sub-
optimal during program implementation of CP5.
The RH component of CP5 in the context of UNFPA’s strategic plan was aligned to facilitate implementation
of national Priorities related to ICPD goals based on national ownership but rights orientation in the program
implementation remained sub-optimal.
2.1.4 Effectiveness
Result and Resource Framework for CP 5 of RH output 1, 2, 4 and 5 is attached as RH Annex 1.
This sub-section explores the extent to which UNFPA has made progress for the achievement of five relevant
outputs under two RH outcomes. One of the limitations of this sub-section is that the lack of clear indicators
and limited baseline and achievement data makes it difficult to assess effectiveness of the RH component.
However, available secondary data and qualitative information gathered from key informants has been used
to assess effectiveness.
RH outcome1: Increased utilization of high quality RH services and information by women, adolescent and
men.
The engagement of UNFPA along with UNDAF partners with MoH has contributed into availability of
contraceptives, enhancing human resource for SBA, promoting adaptation and use of protocols and
standards for family planning, maternal health including the cervical cancer screening and ASRH. The support
for conducting RH program review 2010 and National Aids Control Progarmme review in 2011 and other
studies contributed to development of RH strategy (2012-17).
Output1: Strengthen National capacity to deliver high quality comprehensive RH services.
The key intervention taken up during CP5 towards improving quality of RH services pertains to developing
EmONC protocols, PPH guidelines, IUD insertion manual, etc followed by training of health care providers.
The reproductive health review (2011) found that about 80-96 percent facilities out of surveyed facilities (31)
had relevant standard and protocols available and accessible to health care providers. But, about 29% of the
facilities did not use partogram properly as well as very low number of facilities used parenteral MgSo4 and
antibiotics or performed manual removal of placenta, when required. This indicates scope of improved
supported supervision and improved processes towards compliance of quality standards. The comprehensive
plan to strengthen national capacity to provide SBA development was not taken up but efforts have been
made to build capacity of RIHS responsible for organizing pre and in-service training for midwifery. UNFPA
has provided teaching aids and supported capacity building of 12 faculty members on BCC, SRH and
midwifery. Under South- South Co-operation process of collaboration among RGoB and Government of
Thailand has been facilitated to strengthen maternal health program in the country. The review of RIHS
capacities and recommendation for future action towards quality of midwifery training in RIHS is expected to
pave way for long term planned development of the institution. The RIHS is under the process of revising and
revisiting the curriculum of different cadres of health workers. This provides unique opportunity to integrate
reproductive rights, GBV, Reproductive morbidities etc in pre service curriculum. The process of plan
development for RHCS initiated with the out of country training of seven government officials. Development
of RHCS strategy process was observed to be slow. During CP5, UNFPA took the lead to facilitate processes to
revive and strengthen services for prevention, identification and treatment for cervical cancer. Five doctors,
eighty-two nurses and sixteen technicians have been trained for Pap smear and visual inspection with acetic
acid (VIA) technique. It is reported that 84,397 women were screened for cervical cancer during 2008-11 in
27 hospitals and 103 BHUs covering about 60% of health facilities, a 40% increase from the baseline of 43
health facilities in 2008.The community health unit of JDWNRH has developed SOP for Youth Friendly
Services as well as package for ASRH services.
Output 2: Increased availability of high quality maternal and neonatal health services in selected districts.
This assessment indicates that programme achieved success in equipping 178 BHUs and 20 hospitals for
provision of EmONC. In order to increase availability of SBA, CP5 supported Post Graduation course of four
doctors in OB&GY. About 22 nurses, 25 health assistants and 21 doctors have been trained in EmONC.
UNFPA is supporting procurement of all contraceptives for the country. The modern CPR among women of
reproductive age increased from 19% in 1994 to 36% in 2008. BMIS stated that modern CPR reached 66% in 2010
among women reproductive age currently married or in union. It is reported that almost all health facilities in
the country are providing services of at least three modern contraceptives regularly. Although there was on
statistic on stock out, based on comments made by a number of respondents it appears that the timely
distribution of contraceptives and breakdown of contraceptive distribution chain at health facilities remains
an issue. While UNFPA provided the MOH with a 3-day training logistic information and management system
additional capacity building is needed in logistics and supply system for contraceptives and harmonize
UNFPA‘s contraceptive supply cycle with the national procurement and distribution cycle of drugs and
medicines. As referred later in this report, the quality and use of the logistic system at the central will need
to be improved as part of this process.
UNFPA along with UNICEF supported formation of maternal and neonatal death review committees. This
was followed by a review in 14 out of 20 district hospitals. Unfortunately, the initiative has not moved
forward because Multi-Sectoral Task Force has remained focused on HIV and not other aspects of RH.
UNFPA supported key RH research: 1) Operations Research to examine institutional delivery of cervical
cancer services. The study led to the development of a strategy to enhance the institutional capacity to
deliver high quality cervical cancer services; 2) a national knowledge, attitude and practice survey was
conducted among women to examine Ante-Natal Care (ANC) issues. The study led to the development of age
and cultural appropriate ANC Information Education and Communication (IEC) materials; and 3) The Joint
initiative of UNICEF and UNFPA led to successful completion of Bhutan Multi Indicator Cluster Survey (2010).
Output 4: Improved access to HIV/AIDS in formation and services through high level Advocacy.
The high level advocacy on HIV/AIDS, Family Planning and RH issues facilitated process of assigning high
program priority for critical SRH issues. Moreover, UNFPA with UNAIDS during 2012 started partnering with
LHAKSAM, an NGO formed by people living with HIV and AIDS (PLWHA+) for capacity building of institution
and to generate awareness about causation , transmission and prevention of HIV/AIDS and address social
stigma associated with people living with HIV/AIDS.
RH Outcome 2: Improve access of Young people to life skills education as part of a multi sectorial approach
to the health and development of young people.
During CP5, the proposed interventions under CPD for integrating Life skills education with formal education
system are yet to be materialized. However, MOE has supported and collaborated with UNFPA in creating a
pool of resource people and critical mass of teachers from formal education system to support advocacy for
the integration of LSE. UNFPA in close collaboration with UNICEF engaged Ministry of Education for reaching
to Adult Learners of Non Formal Education (NFE) Centers. It is reported that due to the UNFPA support,
mainly through capacity building, Ministry of Health and Ministry of Education has incorporated reproductive
health, sexuality and gender concerns into the comprehensive school health program. For this purpose, a
guidebook was designed to equip teachers with appropriate material to be used in the class room setting to
build the information and skills of students. By 2012, 714 NFE centers across the country are reached 12,901
NFE learners with SRH and HIV information.
Output 5: Enhanced National Capacity to improve the availability of SRH Education and Services for
Adolescent
UNFPA started partnering with Department of Youth and sports (DYS), Ministry of Education for integration
of Life Skills Education in Formal Education System from the year 2002(CP-4). During CP5, above partnership
continued and during reference period (2008-12) 500 master trainers have been trained in 15 districts with
UNFPA and GFATM support. These master trainers in turn organized training of teachers on LSE and SRH. A
Facilitators Guide has been developed and circulated among School teachers to organize SRH session during
co-curricular activities sessions of the schools. Due to delay in availing formal approval from the Department
of Curriculum, Research and development (DCRD) of Ministry of Education the SRH sessions could not be
integrated in the teaching schedule of formal education System. The unavailability of monitoring data and
reports limits to ascertain effectiveness of this intervention. Simultaneously, during current program, College
of Education responsible for pre-service training of teachers started partnership with UNFPA in 2009 for
advocacy, resource and communication material development towards integration of Life Skills based SRH in
pre service curriculum of teachers. Till now, advocacy efforts have been initiated following formation of core
group and development of teaching module for pilot testing.
2.1.5 Efficiency
There are indications that design of CP5 in the early stages of implementation suffered from a number of
efficiency constraint, the majority of which have now been addressed. The position of Program Officer- SRH
was filled in 2010 and revised M&E framework of cCPAP provided opportunity to integrate desired output
indicators in joint program under UNDAF. Under Delivering as One some efficiency gains were achieved
through Joint programming. One such intervention is related to Humanitarian Assistance during Disaster. The
MISP Component is integrated in the Disaster Response Plan. The partnership with GFATM resulted to create
synergy in reaching to learners with SRH and HIV information to non-formal education centers.
A major proportion of UNFPA’s program fund goes to contraceptive procurement for the country. Condoms
are also being purchased through GFATM and the World Bank. The coordination in the purchasing and
distribution and tracking of commodities could be strengthened.
During CP5, UNFPA partnered for the RH component with Public Sector agencies. The DYS under Ministry of
Education working towards integration of Life Skills Education may not be best option as a partner because
authority and mandate for above intervention to succeed lies with other department of Education Ministry.
This may be causing delay in achieving results.
It was learned during discussions with key respondents that, there were opportunities to further efficiency
gains through engaging professional staffs in more program related activities and less operational functioning
with systematic planning to monitor program progress in the field and take mid-course corrections.
2.1.6 Sustainability
Considering the present progress of CP5, this review believes that it was too early to draw meaningful
conclusions on the sustainability of CP5 interventions. The CP5, however, has contributed to enhancing
capacity of various Implementing partners both at national and sub national levels. At national level, RIHS has
received technical and financial support to build capacity to plan, organize and monitor quality of pre-service
training for midwifery. Whereas at sub national level, despite non availability of evidence for progress, the
support to strengthen health facilities for SBA, provision of screening and treatment of cervical cancer,
support for non-formal education to integrate SRH and HIV/AIDS will contribute to the larger development
goals of the nation along with MDGs and ICPD goals. In addition strengthening of the MOH capacity in
commodities logistics management and forecasting UNFPA has advocated for the RGoB to add a budget line
to purchase contraception.
2.1.7 Impact
As referenced under the context section, the Bhutan has progressed well on MDG 5 and 5b goals in past two
decades. The political commitment of the nation has resulted into USD 72 per capita per annum expenditure
on health care and out of that 88 percent comes from public health financing. The reduction of maternal and
child mortality rates and improvement on other health and demographic indicators places Bhutan much
ahead of many developing countries in the world. UNFPA has been an important contributor to strengthen
cervical cancer services and enhancing skills of health care providers for SBA. In order to provide some
indication of CP 5 impact, this desk review conducted a secondary analysis of selected data drawn from
various reports and surveys. The SBA has increased in Bhutan from 56 percent in 2008 to 64.5 percent in
2010 (BMIS), the percentage of institutional delivery has increased to 63 percent by 2010. In 2010, the
modern CPR reached 66% among women of reproductive age currently married or in union (Ibid).
2.1.8 Facilitating Factors
1. Discussions with UNFPA CO team reveal that regular support from APRO and India CO supported to
strengthen processes and quality of programming.
2. The delivering as one at one side poses a challenge to program differently but this has contributed to
align and harmonized process of programming to reduce operating cost with greater national ownership.
The power of partnership has helped to amplify advocacy efforts and magnify program contribution to
national Priorities, ICPD and MDGs.
3. An open, transparent and positive approach of RGoB and MoH as well as MoE has facilitated success of
UNFPA programs in Bhutan.
2.1.9 Hindering factors
During CP 5 period, three major transitions took place in Health sector and for UNFPA programming. In 2008,
with introduction of new constitution, the political transformation to a parliamentary democracy brought in
fundamental changes to the system of governance along with a far reaching impact on social, economic and
political dynamics. Secondly, the economic growth has facilitated infrastructure and social development
influencing to the change in health issues and health seeking behaviors of people. The expectations of people
are increasing for health sector; burden of non-communicable disease increasing and skewed case load on
secondary level facilities resulting into underutilization of peripheral level health facilities. This had bearing
on assigning program priorities. Thirdly, The UN in Bhutan is a self-starter delivering as one. The Joint
Programming under UNDAF and cCPAP required adjustment and realigning program interventions, as well as
addressing staff capacity and staff turnover.
2.1.10 Key future CP opportunities
From the literature reviewed (RH Review 2011 and the Bhutan Desk Review 2012) key concerns are apparent
for young people’s SRH. These are: 1) High adolescent fertility rate / teen pregnancy; and 2) STIs among
young people. Total population of adolescents (ages 10-19) is approximately 152,240 which constitute 23.9%
of Bhutan Population. Among youth 15 to 19 the fertility rates increased from 46/1,000 live births in 2004 to
59/1,000 live births in 2010. The estimated CPR among this age group was 2.4%. Young people account for
10% of urethra infections, 10% other STIs and 25% genital ulcers. The RH Review 2011 revealed with regards
to STI and HIV that: 1) While 21% of young women 15-24 years old had comprehensive knowledge about
HIV/AIDS, only 9% of young women with no formal education and only 7% of young women of the poorest
quintile had such knowledge; and 2) Use of condoms varied from 22% to 60% despite HIV and STI prevention
programmes (from 22% to 60%). Self-reported reasons for not using condoms included ‘reduced’ pleasure
(35%) and ‘non availability’ (25%).
Factors contributing to unwanted pregnancy and STI included: 1) limited understanding of key SHR issues
among girls particularly in poor communities with no formal education. There is also minimal support to
programmes for out-of-school youth; 2) there is poor policy support for ASRH, with no budget for ASRH, and
implementation of YFHS programme tends to be weak with poor linkages across sectors; and 3) limited
availability of FYS and health workers tend to lack skills and knowledge to provide YFHS; 4) Finally, there is
also limited data available on the issues regarding pregnancy and wanted pregnancy among this age group.
2.1.11 Conclusion
The RH program has made significant progress and has contributed to national priorities as well as of UNDAF
(2008-12).The RH program has strengthened provision of services for maternal health, Family Planning, and
Cervical cancer. The program efforts have contributed into development of National RH strategy to improve
access and quality of SRH services. UNFPA efforts on HIV policy while effective in itself, limited UNFPA
support in improving the access to and quality of HIV services to populations as high risk. UNFPA
concentrated most of youth SRH resources on life skills education versus the provision of high quality YFS.
2.1.11 RH recommendations
The desk review of CP5 (2008-12) found that RH program component is coherent with national strategies and
policies, ICPD and MDGs. The cCPAP under UNDAF provided opportunity for joint programming towards aid
effectiveness.
1. Focus on Young people’s SRH
 UNFPA’s current support on Life Skills Education and Youth Friendly Services should continue in the
next programme cycle.
 The level of resources devoted to LSE appears adequate and should continue in the next country
programme. UNFPA’s support to YFS needs to be strengthened and intensified.
 Technical mission to be supported in order to take stock of young people’s SRH needs, gaps in youth
friendly information, services and related IP capacities, and to develop a YFS framework and action
plan based on National Youth policy and plan of action as well as the Adolescent health strategy .
The stock taking and mapping exercise will help to confirm the CO’s area of work, prioritize its focus
and key interventions, establish strategic links to other partners (WHO, UNICEF, national partners),
as well as build a division of labor.
2. Approach towards programming: Systems Strengthening

 Consolidate smaller and varied activities into more strategic interventions to systematically address
gaps in systems strengthening like HMIS and Logistics and supply system. Consider to proactively tap
opportunities for policy and program design support.
 Integration of reproductive health from Rights perspective in pre and in service training of health
care providers.
3. Dimension of the RH program

 Strengthen and continue focused and strategic support for family planning and purchasing of family
planning methods. As part of this UNFPA, should to work with its counterpart in the Ministry to
incrementally increase its allocation to purchase contraceptive methods over the next 5 years (with a
target of 100% RGoB self-sufficiency), for example by supporting the RGoB integrate contraceptive
procurement into the national budget.
 Safe motherhood – Monitor the quality of training and tracking the progress in implementation
(bEMOC)
 RH morbidities- like cervical cancer-focus on quality improvement for reporting and delivery of
screening services, breast cancer–information provision to women, RTI/STI–advocacy to intensify
provision of quality services.
 Strengthen partnership with Health system/NGOs/faith based organizations to facilitate and support
active community participation to enhance utilization of SRH services.
 Advocacy and policy support for emerging SRH and rights around urbanization, migration, health
sector reforms, and young people
 The CO should explore options to support the MOH and/or other agencies such as RENEW
intensify its efforts to increase sex workers access to quality SHR and HIV services.
2.2 Population and Development
2.2.1 Context
This section of the report examines UNFPA PD achievement using four of the five DAC criteria: relevance,
effectiveness, efficiency and sustainability. Information has been culled from UNFPA CPD, AWP and Quarterly
Reports, and UNDAF cCPAP, MTR, and Joint UN Thematic Reviews, as well as, group interviews conducted
with senior staff at NSB, Royal University of Bhutan (RUB) and Sherubtse College, and UNFPA CO.
The Bhutan 2008 CPD situational analysis found, “significant gaps remain regarding the capacity for policy
analysis and research on population and sustainable development. These gaps constrained the use of data for
formulating plans and policies.” Further analysis by the CO determined that many of the weaknesses could be
addressed through providing support to: 1) strengthen policy makers and planners access to and use of
demographic and statistical data for evidence based policy and programme planning; 2) expanded NSB’s use
of the Population and Housing Census 2005; and 3) the RUB (Sherubtse College) to build the national
capacity in population studies.
UNFPA had two outputs under the PD component of the CP. The first output was to “Enhanced national
capacity at central and local levels to collect, analyse and utilize timely, reliable and disaggregated statistical
data” (Annex PD1: UNFPA CPD resources and results framework). When the cCPAP was developed the output
was aligned to contribute to the UNDAF Outcome “increased access and utilization of quality health
services”. The key national partners were the National Statistical Bureau (NSB), Gross National Happiness
Commission (GNHC). The second UNFPA CP output was to strengthened national capacity to mainstream
population and development studies. When the cCPAP was developed the output was aligned to contribute
to the UNDAF outcome to increase number of people qualified in collection, analysis, reporting and
utilization of population data in policy and programme decision making. The key partner was Sherubtse
College, RUB. The main UN partners for both outputs were UNICEF, UNAIDS and UNDP. While it is beyond the
scope of this desk review, in each case the UNFPA appeared to have worked with RGoB partners who were
strategic in, capable of and dedicated to the successful execution CP PD.
The UNFPA total expenditures in PD from 2008 to 2011 were US$781,515: US$522,548 was used to support
activities with NSB/GNHC under output 1, and US$258,967 was provided to support activities to Sherubtse
College under output 2 (see table 1: UNFPA CP PD expenditures for annual expenditures.
th
Table 3: Allocation and expenditure for PD programming during the 5 CPD.
Year Budget ($) Expenditure ($) Implementation rate (%)
2008 310,000 209,445 68
2009 327,950 229,921 70
2010 217,672 207,043 95

2011 145,937 135,106 93
Total 1,001,559 781,515 78
2.2.2 Program management and partnerships
UNFPA collaborated with UNICEF and UNDP for implementation of the PD component under UNDAF. The
major implementing partners of PD components are – National Statistical Bureau and the Royal University of
Bhutan. The Gross National Happiness Commission is another important partner for UNFPA in PD.
2.2.3 Relevance
Both of UNFPA PD outputs to enhanced national capacity to collect, analyse and utilize timely, reliable and
disaggregated statistical data, and to mainstream population and development studies were aligned with
national priorities stated in the 10th Five Year Plan of the RGoB 2008-2013 on health and education. This
finding was corroborated in the UNDAF Mid Term Review.
UNFPA PD CP was aligned with the Bhutan UNDAF priorities in health and education. UNFPA PD efforts
contributed to delivering on the MGDs 2, 3, 4, 5, 6 (Annex PD2: UNDAF cCPAP and UNFPA-related PD). The
CP PD was aligned to UNFPA’s SP Outcome 7: Improved data availability and analysis resulting in evidence-
based decision-making and policy formulation around population dynamics, SRH and gender equality.
The UNDAF thematic review did not examine whether UNFPA outputs were relevant to meeting the self-
perceived needs of people living in Bhutan in a cultural appropriate way. It was also outside the scope of this
Desk Review. Based on UNDAF theory of change and RRF, UNFPA PD efforts should have contributed to
meeting the needs of people in health and education, and gender.
2.2.4 Effectiveness
Two UNFPA PD outputs were examined for effectiveness. The first UNFPA-related output 1: Enhanced
national capacity, at central and local levels, to collect, analyse and utilize timely, reliable and disaggregated
statistical data) was aligned and contributed to UNDAF Output 1.1: Research and analyses including health
surveillance and monitoring systems, knowledge and behaviour, epidemiology supported by disaggregated
data, where possible, to guide policy, strategies and guidelines development. This UNDAF output in turn
contributed to the UNDAF outcome 1: Capacity of Government strengthened to formulate and implement
results oriented policies and strategies that create an enabling environment for reproductive health,
maternal and child health, STIs, HIV/AIDS, TB and malaria programmes. While the UNDAF Mid Term Review
did not look at UNFPA contribution specifically, it did conclude that, “Progress toward this UNDAF outcome
generally has been satisfactory, with the gradual reduction in maternal and child mortality indicating
judicious and effective use of resources.”
Under this output, UNFPA efforts contributed to the capacity of NSB and GNHC to collect, analyse and utilize
timely, reliable and disaggregated statistical data and to mainstream population and development. The
UNDAF Mid Term Review concluded that the “capacity development of the NSB and GNHC in macroeconomic
research, evaluation methodologies, social policies, data collection, statistical analysis and data processing
has improved quality and professionalism in data collection and information dissemination related to poverty
and the MDGs”. As of May 2012, the programme achieved the following key results:
UNFPA support to NSB focused on capacity development of key staff. With support from UNFPA two NSB
members and one GNHC Official have received Master’s degree in population. This improved capacity
contributed the RGoB use of 2005 census data to conduct Poverty Mapping, as well as apply data with GIS. In
2008, UNFPA supported NSB conduct training of Central Planners in the use of statistics in planning. Thirty-
two planners attended a four-day workshop on the application of population, health and poverty statistics in
their work. Many of central planners who attended the workshop went on to successfully advocate for the
development of population policy. To further the capacity of government planners to use statistics in
planning the course was repeated in 2011 at the district planning level among 60 district planners from 20
districts. In the group interview senior NBS official said that their collaboration with UNFPA was strategic, of
excellent quality and contributed to fulfilling the mandate of NSB to collect and utilize high quality data in
support of national development goals. NSB strong expressed strong interest in continuing collaboration with
UNFPA in the next programme cycle with a strong emphasis on having UNFPA support for the design,
implementation and analysis and reporting on the 2015 Census they will head up. They also expressed
interest in UNFPA continued support in staff capacity building such as the sponsor the Masters degree, and
replicating the workshop on the application of population, health and poverty statistics in the work of block
planners (sub-district level) as a part of NSB support to the national decentralization process.
In 2010 key RGoB decision makers agreed to the need for population policy. In 2010, UNFPA in collaboration
with the Gross National Happiness Commission and National Statistics Bureau developed the Population
Perspective Plan. The Population Perspective Plan covered a range of issues including population growth rate,
urbanization, migration and young people's emerging issues. In total, the population perspective plan stated
21 goals with strategies and action plans to address various emerging population and development issues.
The Population Perspective plan was prepared through consultative processes with senior policy makers,
planners and researchers from government, civil society and multi-lateral donors. The Gross National
Happiness Commission used the Population Perspective Plan to draft its National Population Policy.
An important contribution of UNFPA was its support to the RGoB to draft the evidence-based National
Population Policy. In its current form the policy addresses: 1) Population and Development: Mortality &
Fertility), Reproductive Health, Adolescent Sexual and Reproductive Health (ASRH), HIV/AIDS and STIs, Ageing
population, Differently-abled people, as well as other; 2) Demographic Change and Human Capital; 3)
Demographic Change and Environment; 4) Demographic Change and Poverty; 5) Demographic Change and
Gender: 6) Demographic Change and the Economy; and 7 Demographic Change and Youth. Coordinated by
the GNHC the policy was developed through consultative processes involving the key stakeholders from the
ministries of Health, Education, Human Settlement and Housing and Urban Development, Labour,
Agriculture, Economic Affairs, National Statistics Bureau, National Environment Commission, Ministry of
Home affairs and National Pension and Provident Fund. A key member of the team was the NSB staff who
received his Masters degree in population studies with UNFPA support. UNFPA support contributed to the
formulation of final draft of the population policy which is currently (May 2012) under review by the Gross
National Happiness Commission. The Gross National Happiness Commission chaired by the Prime Minister is
the final review body before policy is submitted to Parliament.
Table 4: UNFPA CPD output 1, baseline and achievements of targets
Output 1: Enhanced national capacity, Baseline Achievement of targets as of May 2012

at central and local levels, to collect,
analyse and utilize timely, reliable and
4
disaggregated statistical data
Improved utilization of population- Census Completed as planned. Population projection used for
related data, particularly from census 2005 Dzongkhag planning, GIS strengthened with infrastructure
2005 report mapping of public institutions has been completed.
National capacities in mapping poverty NA Completed as planned. Report on poverty mapping was
strengthened completed and used for the tenth plan mid-term review.
Improved quality of health information Collection This is an on-going initiative. Use of new data collection form
management system data form with RH related data. Staff trained on data verification.
Increased availability of reliable data on NA Not fully completed as anticipated. According to UNFPA
gender-based violence understanding, the NCWC believes that the country doesn't
have a proper centralist system to capture, analyze and
disseminate to data related to gender and GBV. Data collected
by police, NGOs, hospitals and this need to systematised. This
will be a priority of NCWC during the next five years
Improved consistency of population- Statistics Completed as planned. Published data sheet with selected
based statistical indicators from at Glance indicators. BMIS 2010 report disseminated at all levels and used
th
different sources as baseline indicator for 11 plan.
The second UNFPA-related output 2: Strengthened national capacity to mainstream population and
development studies aligned and contributed to the UNDAF output 2.3a: double subject degree
course on PD introduced at Sherubtse College. The UNDAF output in turn contributed to the UNDAF
outcome 3: By 2012, access to quality education for all, with gender equality and special focus on the
hard-to-reach population, improved5. The UNFPA output indicator was “double subject degree course
on PD introduced”. The baseline was “no such degree course existed at the Sherubtse College”. The
target was to “establish the double degree course at Sherubtse College”. UNFPA was able to achieve
this target. In 2010, UNFPA and Royal University of Bhutan established a double subject degree on
Population and Development studies at Sherubtse College. UNFPA support to Sherubtse College
focused on the design of the population curriculum and the training of four economic professors on
population. In 2010, the first group of 20 students enrolled in the double degree programme. In 2011
an additional 20 students enrolled in the programme. The UNDAF Mid Term Review concluded that,
“the newly designed, UNCT-supported Population and Development degree course at Sherubtse
4
This UNFAP CPD Output relates to UNDAF cCPAP output 1.1: research and analysis.
5
The Desk Review Team does not believe the double subject degree belongs under the access to quality education all
College will enhance capacity of new graduates to fill current human resources gaps in relevant
development areas.” In the group interview senior college official said they are pleased with the
programme and UNFPA support to it. The college plans to offer the double subject degree in 2012 and
anticipate introducing a second double subject degree on population and sociology in 2013/14. They
expressed strong interest in continuing collaboration with UNFPA in the next CP cycle especially in the
areas of expanding the double subject course to include population and sociology, and increase the
use of the college to conduct population studies, and to conduct population training outside of the
college.
Table 5: UNFPA CPD output 2, baseline and achievements of targets
CPD output 2: Strengthened Baseline Achievement of targets as of May 2012

national capacity to mainstream
population and development
6
studies.
PD studies introduced within the NA Completed as planned. Population studies was adopted at Sherubtse
framework of degree programme College and received accreditation. 20 students in 2010 and 20 in
at Sherubtse College 2011 have enrolled for double degree programme at Sherubtse
College.
Skills on data analysis and NA Completed as planned. UNFPA support led to two statistical officers at
dissemination strengthened among NSB and one planning officer at GNHC receiving a Masters degree in
staff of National statistical Bureau population studies. Another planning officer is currently enrolled in
the Master degree programme and anticipated to graduate in 2013.
Population, development and NA Completed as planned. Population Perspective plan finalized and used
environment linkages identified for drafting of the evidence-based National Population Policy.
2.2.5 Efficiency
There is evidence to support that UNFPA CP PD resources were used efficiently. While this summary report
was unable to identify UNFPA specific efficiency statements in the UNDAF Thematic Reports a number of
factors indicated that UNFPA funds were used efficiently. Foremost, UNFPA PD efforts were aligned with and
contributed to broader UNDAF outputs, outcomes, and national development priorities. The UNDAF Mid
Terms Review concluded that, “DaO has allowed better coherence among UN Agencies dealing with health
issues, including UNICEF, UNFPA and WHO, as well as in their interactions with the RGoB”.
While the UN Thematic Review Reports did not examine the efficiency of UNDAF output 2.3a: double degree
programme on PD and economics introduced at Sherubtse College, the individuals who participated in the
group discussion from the RUB and Sherubtse College all agreed that much of the cost in the design,
administration, and teaching the double degree were absorbed at minimal additional cost by the college
existing administrative, facility, and faculty.
Under output 2.1 UNFPA either supported the improved utilization of existing data such as the 2005 census,
or contributed to the improved collection, analysis and utilization national surveys such as Bhutan Multi-
indicator survey, mix of demographic health survey and the multi-indicator cluster survey. In these instances
UNFPA was able to avoid duplication of efforts by ensuring the national surveys took into account key
population issues.
6
The UNFPA CPD output relates to the UNDAF cCPAP output 2.3a introduce degree course on PD at Sherubtse College
Sustainability of UNFPA PD was not investigated in the UNDAF Joint Thematic Reviews. The Review Team did
find evidence, however, that UNFPA’s work with Sherubtse College to introduce and institutionalize the
double degree in population and economics has a high degree of potential sustainable. Senior college staff
said that the student demand for the double subject course was high. In each year the double subject course
was full (20 students in each year). The additional cost of operating the dual degree is minimal for the college
once the initial start up cost in curriculum design and training of professors were completed. The final
indication of potential sustainability came when the department director said the course will continue in
2013 and that the college will introduce a new double subject course on Population and Sociology.
2.2.7 Facilitating factors
UNFPA was successful in achieving the desired results under both CPD outputs due to its strategic
partnerships with IPs who were in the position to delivery results as agreed. In addition, PD approach was to
strengthen gaps in an otherwise well developed and capable institutions. A good example was UNFPA
decision to address the issue of building national capacity in population studies by collaborating with a well-
respected and operating education institute. UNFPA modest but strategic inputs to create support for the
idea, design the curriculum and train professors was all that was required to launch an initiative that will
contribute to the building of national capacity in population studies.
There were no significant hindering factors detected either in the desk review or group discussions with IP
regarding implementation of PD activities or achieving results.
No additional opportunities presented themselves outside of main activities under the UNFPA CP. There is
two opportunities worth referencing. UNFPA should consider how its PD expertise can be used to benefit
data collection, analysis and reporting for: 1) health sector response to GBV; and 2) HMIS.
2.2.10 Conclusion
Based on the desk review and group interview, UNFPA was successful in achieving the intended results under
output 1 and output 2. In each instance UNFPA was aligned to national priorities, UNDAF priorities, and the
UNFPA mission. UNFPA selected IPs appropriate to execute and deliver on intended results. Under output 1
UNFPA contributed successfully capacity development of the NSB and GNHC to formulate and implement
results oriented policies and strategies in health. UNFPA efforts contributed to the demand for and
development of the Bhutan Population Policy, as well the Population Perspective used to guide the
formulation of Population Policy. Under output 2 UNFPA contributed to the successful establishment of the
double subject degree course at RUB Sherubtse college. UNFPAs investment to the initiative was strategic in
that it supported key elements of the double subject degree course including curriculum design and
professor training, while relying on the college to implement the initiative using its own institution systems.
2.2.11 P&D recommendations
1. PD collaboration with the Sherubtse College to provide high-quality training in Population studies to
students and professional is a good example of addressing a national human resource gap using a long-
term and sustainable approach. The Desk Review Team believes that UNFPA should continue its support
of this initiative in the next CP UNFPA support. Areas in which UNFPA could explore the need to support
include:
 Developing the curriculum for the double degree in population and sociology including gender
perspective, as well as training college professors
 Promote opportunities for the college population research center to provide technical services in
population research/evaluation including building capacity of gender analysis, and conduct
workshop population outside the college such as with NSB, NCWC, NGOs/FBO/CBOs.
2. UNFPA collaboration with NSB should continue in the next CP cycle given the importance of the work and
the degree of success achieved. UNFPA should explore at a minimum, the need for its support:
 In the design, implementation, analysis (post census thematic analysis) and dissemination of the
2015 Census to be coordinated by NSB;
 Strategically support NSB’s upcoming initiative to build the capacity of block planners (sub-
district level) in the application of population, health and poverty statistics including
humanitarian response.
2.3 Gender
2.3.1 Context
Gender inequalities are deeply rooted in families, communities, and individual minds, and remain largely
invisible and underestimated in most parts of the world. However, Bhutanese women are in a relatively
better position compared to many neighboring countries in the region, mainly due to gender neutral public
policies, legislation and Buddhist values inherent in the fabric of Bhutanese society.
Low female representation in decision-making positions in governance and higher female unemployment
rate (overall: 3.3% with female at 4.5% against 1.8% male) continue to be of concern in the country. The
female unemployment rate is more pronounced in urban areas and especially among the youth (20-29 years
old). In rural areas, female unemployment is only slightly lower than that of men. This can be associated to
factors such as social expectations and inheritance traditions (matrilineal, although in the southern
communities it is largely patrilineal), which have contributed towards a majority of women being engaged in
the agriculture sector and tied to their homes. However, these engagements are usually low or non-paid
farming and household activities.
While there has been a notable progress in the area of reducing gender inequalities, many disparities prevail
in important areas of development. To address these a National Action Plan for Gender (NAPG) was
developed in 2007 that identified seven critical areas for action: good governance; economic development;
health; education and training; aging, mental health and disabilities; violence against women; and prejudices
and stereotypes. The National Action Plan for Gender provides the basis for gender mainstreaming strategies
Bhutan’s overall development plan through gender sensitization and awareness raising, systematic collection,
analysis and dissemination of gender-disaggregated data.
In broader terms of legal and policy framework, the General Law of 1957 had guaranteed women equality
before the law and the Inheritance Act of 1980 had guaranteed women rights to land and property. Other
laws included the Marriage Act of 1980 and its amendment of 1996 on equality in marriage and family life,
and the Police Act of 1980 and Prison Act of 1982 protecting the rights of women serving prison sentences.
The Rape Act of 1996 is incorporated into the Penal Code of 2004; it protects women against sexual abuse
and provides for severe financial penalties and prison sentences for offenders. Trafficking of women was
prohibited, and Bhutan had ratified, in 2003, the SAARC Convention on Preventing and Combating Trafficking
in Women and Children for Prostitution. The Kingdom of Bhutan signed the CEDAW on July 17, 1980 and
ratified it on August 31, 1981 without any reservation.
Girls’ school enrolment over the last 6 years has shown a steady increase. With the exception of the higher
secondary level, girls’ enrolment as a percentage of total school enrolment is about 50%, at every Level of
general education. The percentage of girls’ enrolment in secondary education has increased from 45% in
2002 to 50.4% in 2011 with an increase of 0.8 % over last year. Women had also overwhelmingly benefited
from non-formal education programme where more than 70% are women learners.
There is increasing evidence of violence against women in Bhutan. According to the BMIS 2010 24% of ever
married women (aged 15 to 49) had reported some form of domestic violence by their husbands. From the
domestic violence cases reported, females are usually the victims of assault and battery. The study also
indicated that acceptance of domestic violence is of concern in Bhutan: 68% of women surveyed justified
domestic violence as permissible if they were not taking good care of their children, burned the food or
refused sex with the husband.
There is no evidence to indicate preference for male child over female and no sex-biased abortions have
been reported among the Bhutanese.i
While efforts have begun to build the capacity of health and law enforcement officials, and community
volunteers, NGOs to respond to gender-based violence, further efforts are needed, particularly in the health
sector.
The following table shows the overall allocation and expenditure for gender programing during the 5th CPD
th
Table 6 : Allocation and expenditure for gender programming during the 5 CPD.
Year Budget ($) Expenditure ($) Implementation Rate (%)
2008 245,400 185,914 76
2009 259,118 211,810 82
2010 180,736 169,834 94
2011 462,600 315,275 68
Total 1,147,854 882,833 77
2.3.2 Programme management and partnerships
The Desk Review confirms that UNFPA made a strategic selection of partners representing government,
NGOs and ROs under the gender section. The partner selection is in line with the three pronged approach to
GBV – intervention, prevention and advocacy at different levels. UNFPA has made conscious efforts to
collaborate with the national machinery of women to ensure the implementation of the policies and laws
relevant to the prevention of GBV. The choice of NCWC shows UNFPA’s commitment to work with the
government agencies to redress the issues of GBV in Bhutan. This partnership could be further strengthened
and regularized by greater involvement of the NCWC.
UNFPA has entered into partnership with two key national NGOs, namely RENEW and Bhutan Nuns
Foundation (BNF). RENEW has long years of experience and achievement in the redress of GBV in Bhutan and
have a wide network around them which represent the government officers, teachers, and community
volunteers. This is the only well-established organization in Bhutan which works in women’s empowerment
and gender based violence issues. During the previous country programme cycle UNFPA supported with the
establishment of RENEW. This organization has the structure to reach the grassroots level through their
community based support system and have the capacity to mobilize women, men, youth, and children
around the issues of GBV. Their organizational vision and strategies are compatible with the UNFPA mandate
and approach. UNFPA has done a partner capacity assessment at the beginning of the country programme
and RENEW has met the required capacity to implement the proposed interventions. UNFPA has been
working with RENEW for two programme cycles. Under the DaO mechanism, the interventions are planned
and implemented through common annual work plans rather than an established partnership strategy.
According to the KAP survey done by Ministry of health in 2010 on maternal and child health, 13% of women
believe that traditional healers and monks can treat pregnancy related illness better than health workers.
Therefore, UNFPA selected BNF as an implementing partner during 2011 to help address women’s health
issues through faith based organization. Established in 2009, the foundation seeks to help make nunneries
leading agents and self-reliant institutions for women. It is committed to women’s education and
empowerment as a way of enhancing their capacity to support society in its search for gross national
happiness. Therefore this partnership would be effective for GBV prevention and engaging the nuns as the
‘agents of change’ in the rural communities which are difficult to reach. This partnership can also be an
instrument to help address the high illiteracy for women in the country (38.7% female are literate compared
to 65% male). While this partnership could be continued, the CO also could explore for opportunities to
collaborate with other similar CBOs/NGOs/FBO and engaging men to respond to GBV.
In addition to these three institutions, UNFPA has entered into agreements with Forensic unit of Ministry of
Health as a key partner to initiate health sector response to GBV. This is a unique partnership in the
integration of GBV prevention, women’s health intervention and advocacy in the health sector. As per the
UNFPA new strategic focus, UNFPA expertise and analyzing country context, this partnership could be further
strengthened during 6CPD.
In addition, at the apex level UNFPA has a strong partnership with GNHC and NSB this has facilitated evidence
based policy development, particularly related to gender. A good evidence for such partnership is, in 2011
with the support of UNFPA, GNHC published a reference book on sex disaggregated data which is widely used
in planning.
The high level advocacy program undertaken by the UNFPA Good Will Ambassador continuous to play
significant role in facilitating policy changes and raising unheard voices to the forefront.
2.3.3 Relevance
Following diagram illustrates the linkages of UNFPA gender programme with relevant plans. Further this
shows the relevance of UNFPA gender strategies compared to the national and international needs.
As mentioned in the diagram, UNFPA’s support in terms of strengthening the capacity of key institutions
and NGOs, including the capacity of health service providers to recognize, report and manage cases of
GBV is highly relevant to the 10FYP since its main focus is to mainstream gender into development as a cross
cutting theme.
In 2007, National Plan of Action on Gender (2008-2013) identified the seven areas of concern such as
women’s low representation in public decision making, women’s equal employment, and insufficiency of sex
disaggregated data, low participation of women and girls in secondary and tertiary education, prejudices and
stereotype, women access to vocational training, women’s health and violence against women as national
needs to be address related to gender. Respecting organizational mandate and expertise, UNFPA was able to
address the concerns related to VAW, women’s health and women’s education (mainly RH education).
Overall planned UNFPA-supported interventions are well aligned with national and international agendas,
policies, plans, and programs regarding gender particularly CEDAW, MDG, SGD, NPAG and with the Beijing
Declaration and Platform for Action.
Although, country programme interventions related to gender are relevant to the UNDAF context (UNDAF
outcome, UNCT outcome and UNCT output), relevancy of some of the implemented activities and country
programme outputs and outcomes could be further strengthened.
2.3.4 Effectiveness
The expected output related to gender is to improve capacity of institutions and health service providers to
respond to GBV. This output will contribute to the reproductive health outcome of strengthen national
capacity to deliver high-quality, comprehensive reproductive health services. The output covers two Key
initiatives: a) strengthening the capacity of key institutions and non-governmental organizations (NGOs),
including the capacity of health service providers to recognize report and manage cases of gender-based
violence; and b) building the skills of health service providers in collaboration with the Royal Institute of
Health Sciences.
UNFPA calls for a dual approach to gender equality that both mainstreams gender across all its activities and
supports explicit programme output on capacity building of institutions to address GBV.
A number of significant gender policy changes have occurred during the CP5 period. The draft Domestic
Violence bill waits discussion in the Parliament. The Plan of Action on Gender (2008-2013) implemented by
the government of Bhutan under the supervision of NCWC where UNFPA as the co-chair took lead in
integrating the planned activities into relevant annual work plans. The GNHC has been developing 11thFYP
with priority for gender. UNFPA has played a role in the development of these policy documents, either in the
form of capacity building of national machineries or through direct support to ensure realization of the plans
and policies. As a co-chair for UNCT gender task force, UNFPA was able to advocate for gender issues at the
various forums at the national level and mainstream gender component across all the 5 UNDAF outcomes.
In 2011, UNFPA initiated joint support to collect, analyze and disseminate Bhutan Multiple Indicator Survey
(BMIS) data in four thematic areas; health, education, youth and gender. This survey was conducted in 2010
by the NSB and thematic analysis was conducted under the leadership of key agencies like Ministry of Health,
Education and NCWC.
UNFPA supported sensitization of Policy makers, Parliamentarians and Planners through supporting them to
participate in the regional and national conferences/meetings on GBV. For gender advocacy, UNFPA Goodwill
Ambassador continues to travel to the remotest parts of the country to advocate on teenage pregnancy,
family planning, HIV/AIDs and substance abuse, and youth issues to reach the unreached population. The
advocacy efforts contributed in the increased knowledge among the females about the family planning, pap-
smear and cervical cancer and importance of the institutional deliveries to reduce maternal deaths. As a
result of her recent visit (8th March 2012) to remote areas 100 volunteers have tested their HIV status.
Around 1,500 people gathered to listen to Her Majesty’s speech on HIV/AIDS, family planning and domestic
violence. According to the evidence this could be considered as a productive advocacy strategy.
With the capacity building initiatives from 2004 onwards, UNFPA supported to establish a fully functional and
competent NGO (RENEW) dedicated to address GBV/DV and women’s empowerment. Following statements
provides evidences for capacity development: a) Availability of shelter home and formation of the survivors
networking group; b) Linkages with other donors especially with IPPF; c) In 2008 community support system
existed only in four districts. Now it has expanded to all 20 districts; d) in 2008 their main target group was
judiciary, police, armed forces, local government leaders and teachers but now the focus has expanded to the
communities; e) In 2008 RENEW had one national consultant to carry out the gender trainings, but now they
have resource pool trained under the UNFPA support; and f) Now RENEW has good organizations structure
with separate departments for community outreach, counseling, programme and finance. UNFPA has trained
RENEW staff on programme and finance management. Compared to 2008, RENEW could strengthen its
partnership with national government especially with GNHC and NCWC. RENEW also established youth
volunteers known as ‘Druk Adolescents Initiative for Sexual Awareness Network’ – DAISON for advocating for
ASRH. The Secretary of GNHC is a RENEW board member. Following factors further reveal their capacity
improvement during the country programme cycle: a) RENEW is a member of GFATM steering committee; b)
Represent task force of domestic violence bill; and c) lead in developing police training curriculum. During the
country programme cycle RENEW was able to provide services for 1,007 clients on gender related issues of
which 836 (83%) constituted new clients and 69 (7%) old clients; rest 102 (10%) were other cases not under
RENEW’s mandate and which were further referred to concerned agencies.
With UNFPA support a systematic GBV redress mechanism was introduced to the health sector and the
capacity development process initiated. At the moment UNFPA supports the Forensic unit of Ministry of
Health to strengthen their capacity as mentioned in the country programme document. Under the UNFPA
support three forensic staff members were trained on GBV case management.
UNFPA strengthened capacity of BNF to introduce gender equality, reproductive health, ASRH, teenage
pregnancy and alcoholism through LSE approach in the nunneries. A module on Life skills education including
RH and Gender has been developed and these 150 nuns were sensitized using this module. During the
workshop one of the participants has said “by attending this kid of training is very important for us. It helps us
to support communities we live facing domestic violence and health issues. We can go back and discuss these
issues with local people”. This brings evidence for the effectiveness of Life Skills Education. BNF could
organize first nun’s conference under the support of UNFPA. Total 250 nuns attended to the conference and
it was an opportunity for them to discuss the RH and gender related issues pertaining to the. Further this was
an eye opening advocacy event for both nuns and policy makers. Hon. Prime Minister of Bhutan committed
to support the development of nuns education and other issues.
Table 7: UNFPA CPD output 3, baseline and achievement of targets
CPD output 3: Improved capacity of Baseline Achievement of targets as of May 2012

institutions and health service providers to
respond to gender-based violence
 Number and percentage of key 2 (RENEW 4 (RENEW, BNF, NCWC, WCPU), gender focal in 20
government agencies and NGOs & NCWC) ministries (each participant attended a five day training)
trained on gender-based violence
 Stakeholders skilled in designing NA RENEW staff, volunteers, teachers, BNF staff, nuns,
multisectoral response to gender- 20 gender focal points in 20 ministries, NCWC, MOH
based violence forensic unit (each participant attended a five day training)
 Percentage of health service providers NA 3 health service providers under the partnership of MOH
and law enforcement personnel skilled attended a five day training
in identifying and managing cases of
gender-based violence Police Officers SPs from 20 districts attended a five day
training
 Number of facilities providing services NA RENEW and BNF. Through RENEW, the community based
to address gender-based violence support system is in place in 20 districts.
2.3.5 Efficiency
The budget distribution for Gender among IPs remained inconsistent throughout 2008-2011, with the largest
proportion of budget (74%) allocated for RENEW for five year period. NCWA programming accounted around
11% of the budget on average from 2010 till date; an average of 15% of the budget was allocated for BNF in
2011.
Chart 3: Budget distribution among IPs (2008-2012)
There is significant underspending of funds by NCWC (USD 27,547) compare to the other implementing
partners. This is a considerable amount in comparison to the total budget. Further NCWC implementation
rate remains at 72.10 (BNF 99.42 and RENEW 99.89). This is a low implementation compared to the other
implementing partners. This is a factor which influences overall efficiency of the progrmme.
There were delays in the disbursements of funds from the Department of public accounts to both the
government and NGO implementing partners under the national execution modality. This resulted in the
delayed implementation of activities of the implementing partners. Further delays in the joint AWP clearance
process also affected the timely implementation of the programme. The timeline and procedures for
preparation and approval of AWPs and fund transferring may have to be reconsidered if the country
programme is to be managed and implemented efficiently.
At the moment CO staff is over stretched under the pressure of DAO. Time consumed by DAO requirements,
therefore losing focus of UNFPA programs. Further capacity of the UNFPA staff related to gender could be
improved and this could lead to enhancement of overall efficiency and quality of achieving results.
Sustainability is questionable with regard to inputs in capacity development. Under CP5, UNFPA has
implanted several initiatives for capacity development of IPs, mainly the NGOs. (RENEW, BNF). However, in
the absence of an exit plan and documented capacity development strategy, the implementing partners
remain dependent on UNFPA support to continue these critical activities. UNFPA can help facilitate the
transition towards greater sustainability of these services by incorporating capacity building of government
medical staff, coupled with facilitative supervision for quality assurance, in future contracts with the
implementing NGOs.
With regard to the health sector response to GBV, whole support goes to the Forensic unit of the Ministry of
Health, which is run by one medical doctor. There is no proper systematic approach to address GBV within
the health sector. Hence sustainability of this intervention needs to be considered.
Another important positive element is the support to key government actors such as NCWC that allows long-
term strategies across successive programming cycles. Hence, initiatives such as UNFPA support to NCWC to
draft the DV bill, has a clear sustainability.
2.3.7 Impact
As mentioned in the partnership section, UNFPA has identified the correct partners for country programme
implementation. RENEW and BNF are the main national NGOs in Bhutan who work for gender issues
(DV/GBV/community response to gender issues). UNFPA provides 70% funding for RENEW and almost 80%
funding for BNF coming from UNFPA. Hence UNFPA interventions contribute to the overall impact. The table
below shows that more domestic violence cases, which include assault and battery and other forms of
violence and harassment, are increasing being reported. According to the recent GBV survey conducted by,
this could be attributed to increase awareness in the community through the NGOs and government
institutions.
Table 8: Domestic violence cases reported in the country within 2007-2009

Year Assault Battery Rape Incest Child Total cases
molestation /
Husband Wife Husband Wife
Sexual
assaulting assaulting battering battering
harassment
wife husband wife husband
2007 14 1 263 8 1 287
2008 11 4 311 11 1 2 340
2009 24 3 392 17 1 437
Total 49 8 966 36 2 1064

7
Source: SP, Crime & Operations, Royal Bhutan Police, Thimphu, 2009
2.3.8 Facilitating factors
Commitment of the implementing partners, based on observation during interviews was found to be
commendable. Similarly, in the Country Office, professional contributions of the programme staff and the
strong partnerships with implementing agencies that they capitalize upon were distinct assets to the country
programme. E.g. NCWC appreciates UNFPA partnership and support especially in DV bill drafting process.
UNFPA plays a leading role in Gender in Bhutan. UNFPA chairs UN gender task force and always play a leading
role in policy development related to gender and mainstreaming gender components across UN supported
intervention.
UNFPA’s collaborating with the faith based approach for GBV prevention is a very effective strategy,
especially the country like Bhutan where nuns/monks play leading role in social change process. Hence the
partnership with FBO like BNF needs to be continued and consider expanding the collaboration with other
FBOs.
UNFPA has initiated institutional based advocacy programs, this could be cost effective.
7
Gender Statistics Bhutan 2010. “Women 2000: Gender equality, development and peace for the twenty-first century”
Outcome of the twenty-third special session of the General Assembly. Commission by Research & Evaluation Division, Gross
National Happiness Commission.
During CP 5 period, major transitions took place for UNFPA programming. In 2008, with introduction of new
constitution, the political transformation to a parliamentary democracy brought in fundamental changes to
the system of governance along with a far reaching impact on social, economic and political dynamics. The
rural urban migration (6%, highest in South Asia as per UNDPs human development report), huge
unemployment among youths (9.2%) continues to be a major challenge in the country. The UN in Bhutan is a
self-starter delivering as one. The Joint Programming under UNDAF and cCPAP required adjustment and
realigning program interventions. Availability of reliable data and systematic collection, analysis and use of
data related to VAW in planning needs further attention.
With regard to future opportunities in gender, the material reviewed reiterates the position of UNFPA to
continue and develop its work on GBV. It is evident that the health sector response to GBV needs to be
improved and coverage expanded, as currently whole support goes to the Forensic unit of the Ministry of
Health, run by one medical doctor.
Working with the right IPs allows UNFPA to build on the achievements in the area of gender, to build linkages
linkages between the strategic focus areas in the next CP.
2.3.11 Conclusion
Based on the desk review and group interview, UNFPA was successful in achieving the intended results under
output 3 of the reproductive health outcome and mainstreaming gender in other sectors. In each instance
UNFPA was aligned to national priorities, UNDAF priorities, and the UNFPA mission. But as mentioned under
the Relevant section, interventions carried out under the output 3 is could be better aligned with relevant CP
outcome. UNFPA had selected correct IPs to achieve intended results and contributed successfully in capacity
development of them. But review team could observe that a strategic approach to capacity building needs to
be strengthened. Further, the gender component could be strengthened through application of right based
approach during the next program cycle. Although UNFPA has come to a partnership with Forensic unit of
Ministry of health expecting reproductive health approach in GBV prevention, this needs to be systematized
within the health system.
2.3.12 Gender recommendations
1. The CP should focus it gender efforts on building the national capacity in the health sector’s response to
GBV. Strengthen the health sector’s response as part of multi sectoral approach to integrate GBV as
public health issue in health system and programs through capacity building of health care providers,
developing protocols and guidelines and develop MIS. While UNFPA comparative advantage is in health
sector’s response to GBV this needs to be developed within multi-sectoral approach. The multi-sectoral
approach necessitates UNFPA working in collaboration with other UN Agencies. As an initial step in the
process we suggest that the UNFPA and other UN Agencies support a mission (experts in the fields of
health sector response to GBV, multi-sectoral response to GBV, and national GBV data) to conduct a
needs assessment and support the design a pilot project to health sector’s response to GBV within multi-
sectoral approach. The Mission would focus on existing GBV policy, legislation, and gaps; the MOH
structure and capacity to implement a health sector to address GBV; existing support mechanism and
linkages to other key partners such as the Forensic Medical Unit (to document evidence/cases), and
RENEW (to build community-base awareness and referral work); GBV data needs; and the framework a
multi-sectoral response to GBV.
2. The CO should explore ways to improve the utilization, as feasible and appropriate, of its strategic
alliance with IPs to advance the work on its next CP priorities. LSE for ASRH, awareness on reproductive
health and rights, and harmful practices. The purpose is to guide the CO strategically position IPs where
they can have the greatest impact. This exercise should be done in collaboration with other UN agencies
such as UNWOMEN and UNICEF.
3.0 Country Programme recommendations
1. Build a robust monitoring and evaluation system. As an initial step the CO and IPs should improve
capacity their results-based management and evidence based programming under the next country
programme. This process should start however in the final year of CP5. UNFPA needs to strengthen its
RRF (theory of change), indicators, baseline and endline, and its CP monitoring and evaluation system.
Optimally this would be done in collaboration with UNCT through the UNDAF process. The next step
would be work with the UNCT, CO, and IP to build a robust and integrated M&E system.
2. Country office should focus development of systems for country office management and programme
development. During the review process review team found that country office is strongly driven by DAO
initiative (UNDAF/cCPAP). The CO needs to strengthen its systems to facilitate overall quality of the
program delivery. Hence, review team would recommend country office should give a priority for
development of following systems.
 Systematic approach for country office communication and advocacy interventions
 Systematic approach for country office staff capacity development
 Introduce systematic approach for knowledge building/sharing
 Improve proper reporting system inline with UNFPA reporting requirements
 Systematic field monitoring system
4.0 Desk review utilization
The report will be used as advocacy material to position UNFPA support to RGoB under delivering as one.
It will also be disseminated in hard and soft copy to various ministries, agencies, and CBOs and UN and
other development partner agencies.
Annex1: Desk Review TOR
Terms of Reference for desk review for 5th CPD (2008-2013).
Background and rational
In support of the country’s development in the 10th Five Year-Plan period, the 15 UN agencies operating in
Bhutan had mutually agreed with the Royal Government of Bhutan to United Nations Development
Assistance Framework (UNDAF 2008-2012) and the UNDAF operational tool, the common Country
Programme Action Plan (cCPAP). To enable formulation of the 10th Five Year-Plan and the UNDAF 2008-2012
with subsequent extension to 2013, the Royal Government of Bhutan and UN had jointly carried out a
Common Country Assessment (CCA), assessing the development situation of the country and serving as the
basis for preparation of UNDAF. Based on the findings of 2006 Common Country Assessment, UNFPA 5th CPD
was approved by the UNFPA Executive Board with total allocation of USD 5 million.
The main components of the CP5 included:
(a) Reproductive Health, including maternal health, adolescent sexual reproductive health and HIV/AIDS
prevention;
(b) Population Development Strategies which include development of statistical capacity and availability and
utilization of population data disaggregated by sex and age and;
(c) Gender component is to strengthen institutional mechanism and empower communities to protect the
rights of women through capacity building of the government, non-governmental organizations to prevent
and respond to gender-based violence.
As the country now embarks on preparation for 11th Five Year-Plan period (July 2013 – June 2018), the UN
agencies operating in Bhutan (both resident and non-resident) are also preparing the planning of UN support
to the country’s development for the cycle 2014 – 2018. The UN in Bhutan conducted a series of Joint UN
Thematic Evaluation/Reviews to replace the final Joint UN evaluation report. The UNCT decided to conduct
both Comparative Advantage Analysis (CAA) and the Country Analysis (CA) as one of the major steps in the
process of formulation of the UNDAF Action Plan based on existing joint reviews, surveys, assessments and
evaluation reports. In order to supplement the UNDAF process and to fulfill UNFPA’s EoP evaluation needs,
CO will conduct a desk review of the current Country Programme based on the Joint UN, Government and
UNFPA documents. The review report will assess the achievement of the 5th cycle programme including
challenges, achievements and lessons learned which will guide development of 6th CPD in line with UNDAF,
11FYP and UNFPA new strategic plan.
Main objectives of the Desk Review are to:
 Assess and document the extent to which the 5th CP has achieved its outputs and contributed to its
intended outcomes including ICPD programme of action, MDGs and other national priorities.
 Document lessons learned, challenges and best practices
 Document comprehensive recommendations that can be applied to the next CP strategies in line
with 11FYP, UNDAF and UNFPA SP.
SCOPE OF THE DESK REVIEW:- The review criteria and questions of CP applicable to the three programmatic
areas (RH, Gender and PDS) are as follows:
RELEVANCE
 Is the programme designed inline with national needs and priorities?

 Is the programme inline with ICPD programme actions and MDGs?
 Is the cCPAP design intuitive and logical? Does it efficiently enable desired project outputs? Do the
stated needs of the beneficiaries appear to have accurately assessed?
EFFECTIVENESS
 Have the inputs and activities led to the output and outcomes (or is there reason to believe the
activities will do so during the remainder of the programme?
 What are the constraining and facilitating factors and the influence of the context on the
achievement of the results?
 To what extent does UNFPA intervention contributed to the capacity development and the
strengthening of institutions in Bhutan
EFFICIENCY
 What is the quality of the outputs and outcomes achieved in relation to the expenditure incurred
and resources used?
 To what extent has the CP utilized the capacity and expertise of the UNFPA staff/human resources?
 Is the staffing setup of the UNFPA CO appropriate for the effective and efficient implementation of
the CPD in the context of DAO?
 Whether the partners selected to implement the cCPAP interventions were the right ones.
IMPACT
 How long-term results been achieved or are likely to be met?

 What has happened or is likely to happen as a consequence of UNFPA efforts?
SUSTAINABILITY
 Will the programme have lasting results?

 Are counterparts willing and able to continue programme activities on their own?
 Have programme activities been integrated into current practices of counterpart institutions and/or
target population?
 How effective are the partnerships that UNFPA has established?
 Did programme design include strategies to ensure sustainability?
METHODOLOGY
Team of three UNFPA staff (RH expert, M&E expert and Evaluation expert) will undertake the assignment.
Guided by the overall delivering as one objective, the review team members will work towards reviewing
existing documents to incorporate the UNFPA specific needs to fulfill the CP evaluation requirements and
contribute to CA and CAA and guide the country office with development of 6th CPD in alignment with 11FYP,
UNDAF and new SP.
 To produce a Final Report based on the review of UN Joint Evaluations/Assessments/ UNFPA

Thematic Evaluations, Secondary Data (DHS/National Survey), and focus group discussion with IPs to
compensate for gaps in data.
 Review the 11FYP and bring forward opportunities for linkages or integration with the 11th Plan
indicators, UNDAF and UNFPA strategic planning.
Duration of the assignment: 5th to 15th May 2012.
EXPECTED DELIVERABLES:-
1. Detailed outline summary Report outlining the extent to which the 5th CP has achieved its
outputs and contributed to ICPD programme of action, MDGs and other national priorities
including lessons learned, challenges and best practices.
2. Comprehensive End of Programme Summary Report that responds to UNFPA EoP evaluation
requirements, including the CO’s need to supplement the UNDAF EoP Evaluation when critical
information gaps exist and recommendation for way-forward for 6th CP development in line with
11FYP, UNDAF and UNFPA new strategic direction.
Annex 2: Report Format
1. Title page
2. Table of Content
3. Acronyms
4. Exe Summary (3 pages)
5. Main Text: (introduction; methodology; findings by three thematic areas RH/FP, Gender, P&D (taken
from existing reports and one workshop discussion on demography); conclusions; recommendations
(5 prioritized recommendations, maximum) 25 pages.
6. Annex.
Annex 2: List of persons interviewed
Name Title Organization
Mr. Rinchen Wangdi Chief Programme Coordinator GNHC

Ms. Tandin Lhamo Programme Coordinator GNHC
Reproductive health
Mr. Kinga Jamphel CPO DVED, MoH
Ms. Saraswati Dorjee PO DVED, MOH
Ms. Ugyen Zangmo Sr. PO RH Dividion, MoH
Dr. Sonam Ugen CPO CHU, JDWNRH
Ms. Rinzin Wangmo CPO DYS, MoH
Ms. Deki Tshomo Dy. CPO DYS, MoH
Mr. Bijoy Kumar Rai Lecturer, Primary Science College of Education, Paro
Dr. Chencho Dorji Director RIHS, RUB
Ms. Sonam Deki HoD Midwifery Department, RIHS, RUB
Population and Development
Dr. Singye Namgay Director Sherubtse College
Mr. Jamyang Choeda Programme Manager Sherubtse College
Mr Gajel Lhendup Director Royal University of Bhutan
Mr Kuenga Tshering Director General National Statistics Bureau
Mr. Phub Sangay Chief Statistical Officer National Statistics Bureau
Mr Pem Namgay Statistical Officer National Statistics Bureau
Gender
Dr. Pakila Drukpa Head of Department Forensic Unit, JDWNRH
Mr. Sonam Penjor Programme Officer NCWC
Ms. Tshewang Lhamo Programme Officer NCWC
Dr. Meenakshi Rai Director Out Reach, RENEW
Ms. Dolma Teacher RENEW Volunteer
Ms. Dorji Lham Youth RENEW Volunteer
Ms. Sonam Chhoki Programme Assistant BNF
Dr. Chencho Dorji Board Member BNF
Annex 3: Desk review documents
1. Assessment of situation of young monks and nuns in Monastic institution (hard copy)
2. A rapid assessment Sexual Behaviors and networks in Bhutan (Hard Copy)
3. 11FYP NKRS and SKRS, GNHC, RGoB
4. Population Perspective Plan 2010
5. Bhutan Multi Indicator Survey 2010
6. Final Joint Health Sector Review 2012, Bhutan
7. Health Care costing 2011
8. National Health Accounts July 2011, MOH, RGoB
9. Mid-term report 10 FYP
10. National AIDS Control Program review 2011
11. National Health Policy 2011
12. National Reproductive Health strategy 2011
13. National Youth Policy
14. Draft National Population policy- RGoB, April 2012
15. Population Policy Background Document
16. Population and Development Situational Analysis RED,GNHC Bhutan 2010
17. Population Perspective Plan 2010 (Draft)
18. KAP survey on MCH 2010
19. Reproductive Health Review Bhutan 2011
20. Eleventh Round Table Meeting 2011
21. Review of existing capacity of RIHS for in-service training and recommendation for capacity building
March 2012- Dr. T.V Chacko
22. UNDAF MTR 2011
23. Common Country Assessment of Bhutan-2006-UN Bhutan
24. UNFPA strategic plan 2008-11., accelerating progress and national ownership of ICPD PoA July 2011
25. Mid-term review of UNFPA strategic Plan 2008-2013
26. Country Programme Document for Bhutan (DP/FPA/CPD/BTM/5/24 July 2007
27. UNDFA framework for RGoB 2008-2012, June 2007
28. Common country programme action plan 2008-2012, December 2012
29. Summary note- review of UNFPA CP5 programme support in Bhutan 18/23 November 2010-UNFPA
APRO
30. Annual Health Bulletin 2011, MOH, RGoB
31. Health System Rapid Assessment, 21 August 2011, MOH, Bhutan
32. Report on gender mainstreaming
33. Study of Gender Stereotypes and Women’s Political Participation (Women in Governance) 2009
34. Glass ceiling in the educational curve for girls? -assessing girls’ participation in education at higher
secondary level in Bhutan, 2009
35. Gender Statistics 2011
36. Study report on Women’s political participation in 2011 local governance election.
37. Gender Guidelines Strategic Framework: Gender mainstreaming and Women’s Empowerment 2009
38. Report on gender study for Ministry of Economic Affairs, 2009
39. Gender Strategy Helvetas, 2008
40. Annual workplan 2008-09, 2009-2010, 2010-11, 2011-12 Health and Education,
41. UNDAF M&E framework.
42. UNFPA Bhutan Annual Work Plans
43. UNFPA Bhutan Quarterly Reports
44. UNFPA Bhutan Country Office Annual Reports
Annex 4: General observations and suggested items for country office consideration
1. CO capacity: longterm/detail assignment of an expert who can guide the CO towards effective and
efficient program delivery.
2. Positioning UNFPA within UNDAF. UNFPA is well represented in the UNDAF, UNCT. More attention
should be given by UNFPA to ensure that ICPD is clearly reflected in UNDAF documents such as the
UNDAF and cCPAP.
3. UNFPA team should continue actively engaging in influencing larger program through ongoing
development processes. The 11th FYP is in the formative stage and placing appropriate indicators
relevant to RH & R, LSE etc will help to influence sector-wide programming in line with ICPD and MDGs.
4. The UNFPA team should maintain leadership in the areas of UNFPA comparative advantage like SRH,
GBV, Reproductive rights etc while remaining a committed member of the delivering as one team.
5. UNFPA should identify and tap opportunities to leverage resources of National and Development
partners to magnify results. The intervention should be considered in the holistic manner and logical
connect with forward linkages rather than stand-alone activities or events.
6. Systematically plan monitoring and field visits to regularly observe and access not only UNFPA supported
programs but also RH and Health Sector to remain more relevant for identifying technical assistance
needs and provide critical support at policy and program level. The team also observed a need for
additional monitoring vehicle for effective monitoring.
7. Capacity building of M&E officer through attachment programs with other UNFPA agencies with
availability of strong M&E Officer in the region.
8. New local recruits have not had an opportunity for formal induction/orientation program therefore there
is an immediate need for an attachment at UNFPA Cos within the region to build their capacity
specifically for procurement and finance.
Annex RH 1: UNFPA CPD results and resource framework 2008

Annex PD1: UNFPA CPD PD resources results framework
National priority: to halve poverty by 2013

UNDAF outcome: by 2012, opportunities for generation of income and employment increased in targeted poor
areas
Population and Outcome: Output 1: Enhanced national Key $1 million
development Increased availability and capacity, at central and local government from regular
utilization of levels, to collect, analyse and ministries and resources
disaggregated statistical utilize timely, reliable and national
data for policy, strategy disaggregated statistical data institutions at
and programme Output indicators: central and
development and  Improved utilization of local levels
implementation at population-related data,
national, subnational and particularly data from the United Nations
sectoral levels 2005 population and organizations Total for
Outcome indicators: housing census and selected programme
 Increased percentage  National capacities in donors coordination
of national, mapping poverty and
subnational, and strengthened assistance:
sectoral policies take  Improved quality of health $0.25 million
population variables information management from regular
into account system data resources
 Increased availability of  Increased availability of
data that is reliable data on gender-
disaggregated by based violence
geographical area, sex  Improved consistency of
and age population-based
 Strengthened national statistical indicators from
capacity in the area of different sources
population and
development Output 2: Strengthened national
capacity to mainstream
population and development
studies
Output indicators:
 Population and
development studies
introduced within the
framework of a degree
programme at Sherubtse
College
 Skills on data analysis and
dissemination
strengthened among staff
at the National Statistical
Bureau
 Population, development
and environment linkages
identified
Annex PD2: UNDAF CCPAP: UNDAF cCPAP and UNFPA-related PD
UNDAF CCPAP: UNFPA PD related support under UNDAF Outcome 3, CT Outcome 2, CT outputs 2.3a
Annex PD3: UNDAF Mid Term Review: CT Outcome Rating from MTR Evaluations and Self-Assessments
Overall Midterm
Relevance Clarity Sustainability
CT Outcome Progress
Capacity of Government strengthened 3 3 3 3

to formulate and implement results-
oriented policies and strategies that
create an enabling environment for
reproductive health, maternal and child
health, STIs, HIV/AIDS, TB and malaria
programmes
Legend and explanation:

How important the UNDAF cooperation strategy, and the
Represents outcomes on objective it stands for, is in Bhutan’s current situation.
Relevance
1 which further improvements Applicability to national development issues, policies and
are necessary priorities, including GNH, and/or to internationally
recognized goals, commitments and obligations
How well the UNDAF presents the case for the UNCT to
Stands for satisfactory Clarity pursue this objective together; how well the strategies,
2 progress actions and inter-linkages are defined, and how strongly
they are linked to measurable indicators
How well the UNDAF cooperation strategy meets Bhutan’s

needs of the present, particularly for the most vulnerable,
Sustainability
3 Stands for good progress as well as transcends constraints/limitations to meet the
needs of the future; the potential for long-term
maintenance of progress
i
Source: National RH survey completed in 2011
th
Annex 5: 11 Five Year Plan (This is draft document and to be used as a reference only). Click to open file:
..\Bhutan documents\11th FYP NKRA-SKRA-FINAL.PDF
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DESK REVIEW I UNFPA 5th COUNTRY PROGRAMME 1

UNFPA Bhutan Country Office, May 2012

UNFPA Bhutan Country Office

Richard H. Columbia, PhD

List of abbreviations and acronyms 06

2.2 Population and development 24

2.3.2 Programme management and partnerships 31

3.0 Country Programme recommendations 39

4.0 Desk review utilization 39

List of abbreviations and acronyms

AIDS Acquired immunodeficiency Syndrome

NCWC National Commission on Women and Children

UNFPA Bhutan fifth country programme

Findings and conclusion

Key future CP opportunities

Picture 1: Administrative map of Bhutan

UNFPA fifth country programme in Bhutan

Table 1: CP 5 budget 2008_2011 (Regular and other sources)

Diagram 1: Country programme structure

1.2 Desk Review purpose and objectives

1.2.1 Desk review scope

1.3 Desk review methodology

1.3.1 Data collection methods

1.3.2 Desk review team

1.3.3 Stakeholder participation

1.3.4 Ethical consideration

1.3.5 Challenges and limitations to the desk review

1.3.6 Structure of the report

2.0 Desk review findings

2.1 Reproductive Health

2.1.2 Program management and partnerships

Result and Resource Framework for CP 5 of RH output 1, 2, 4 and 5 is attached as RH Annex 1.

Output1: Strengthen National capacity to deliver high quality comprehensive RH services.

2.1.8 Facilitating Factors

2.1.9 Hindering factors

2.1.10 Key future CP opportunities

1. Focus on Young people’s SRH

2. Approach towards programming: Systems Strengthening

3. Dimension of the RH program

2.2 Population and Development

2010 217,672 207,043 95

2.2.2 Program management and partnerships

Table 4: UNFPA CPD output 1, baseline and achievements of targets

Output 1: Enhanced national capacity, Baseline Achievement of targets as of May 2012

Table 5: UNFPA CPD output 2, baseline and achievements of targets

CPD output 2: Strengthened Baseline Achievement of targets as of May 2012

2.2.7 Facilitating factors

2.2.8 Hindering factors

2.2.9 Key future CP opportunities

2.2.11 P&D recommendations

2.3.2 Programme management and partnerships

Table 7: UNFPA CPD output 3, baseline and achievement of targets

CPD output 3: Improved capacity of Baseline Achievement of targets as of May 2012

Chart 3: Budget distribution among IPs (2008-2012)

Table 8: Domestic violence cases reported in the country within 2007-2009

2007 14 1 263 8 1 287

2008 11 4 311 11 1 2 340

2009 24 3 392 17 1 437

Total 49 8 966 36 2 1064

2.3.8 Facilitating factors

2.3.9 Hindering factors

2.3.10 Key future CP opportunities

2.3.12 Gender recommendations