May 20, 2025
THIMPHU – Bhutan has launched an ambitious new roadmap to improve the health and survival of mothers and newborns. The Bhutan Every Newborn Action Plan (BENAP) 2025–2029, released by the Ministry of Health, signals a renewed national commitment to eliminating preventable newborn deaths and stillbirths, while strengthening the country’s health system.
The plan sets sharp new targets: reduce newborn mortality to 5 per 1,000 live births, stillbirths to 2 per 1,000, and maternal mortality to 40 per 100,000 live births by 2029. These targets build on the progress achieved under the previous BENAP (2016–2023), during which Bhutan surpassed the global Sustainable Development Goal (SDG) threshold for neonatal mortality.
The 2023 National Health Survey (NHS) reported a neonatal mortality rate of 6.9 per 1,000 live births—well below the SDG benchmark of 12—and a maternal mortality ratio of 53 per 100,000, nearing the global target of 70. Stillbirths, though estimated at 9.0 per 1,000 total births in 2021, are projected to fall to 6.8 by 2030. However, the NHS 2023 cited an unusually low stillbirth rate of 1.3 per 1,000, calling it unrealistic due to incomplete data and poor surveillance.
The new plan is rooted in a national review of the earlier BENAP and shaped through extensive consultations with government agencies, healthcare workers, academia, civil society, and communities. Three national and three regional consultative meetings were held, supported by field visits, online surveys, and focus group discussions.
Despite Bhutan’s near-universal institutional delivery rate—94.1 percent of births in 2023 took place in hospitals—the distribution and quality of services remain uneven. Only 12 hospitals conducted more than 100 deliveries last year, accounting for over 83 percent of total live births.
In contrast, the majority of Public Health Centres (PHCs) and sub-posts recorded no deliveries at all. Of the country’s 284 health facilities (52 hospitals, 184 PHCs, and 48 sub-posts), 130 conducted fewer than 10 deliveries.
To address these disparities, BENAP 2025–2029 proposes a series of structural reforms. These include continuous training for health workers, integrating maternal and newborn health into university curricula, and establishing advanced midwifery courses. Infrastructure upgrades and the expansion of digital health systems are also central to the plan.
Implementing these strategies will require an additional annual investment of USD 578,627. However, the plan highlights long-term returns estimated between USD 55 million and USD 79 million—gains to be made through saved lives, reduced disability, and enhanced economic productivity.
Equity is a guiding principle of the updated BENAP. While Bhutan’s income inequality has improved—reflected by a fall in the Gini index from 37 in 2017 to 28 in 2022—gaps in health access persist, particularly due to geography and poverty. The plan aims to bridge these through decentralised services, better referral systems, and mobile outreach in remote areas.
Community engagement is also a priority. The plan promotes people- and family-centred care, such as enforcing zero separation between mothers and newborns and boosting health literacy through civil society partnerships. The Nurturing Care Framework, which supports early childhood development, will be integrated into services from birth.
Data reliability remains a critical concern. In 2023, 52 neonatal deaths were reported, with 69 percent occurring in hospitals, 29 percent in transit, and 2 percent at home. Underreporting, especially in rural areas, is believed to be widespread. To improve this, BENAP will strengthen the Maternal, Perinatal and Neonatal Death Surveillance and Response (MPNDSR) system, enhance civil registration and vital statistics, and train staff in accurate cause-of-death certification.
The major causes of neonatal death in Bhutan are sepsis (29 percent), prematurity (23 percent), birth asphyxia (19 percent), and congenital anomalies (19 percent). More than half of the deceased newborns were preterm or of low birth weight, and 42 percent of the deaths were linked to maternal health conditions—underscoring the need for holistic maternal care.
Emerging health challenges are also addressed. Non-communicable diseases such as gestational diabetes, hypertension, and obesity are increasingly common and linked to adverse pregnancy outcomes. BENAP incorporates screening and management of these conditions into maternal health services and promotes healthy lifestyle interventions under Bhutan’s ‘Service with Care and Compassion’ programme.
The COVID-19 pandemic revealed critical weaknesses in the health system, including staff shortages and service disruptions. In response, the new BENAP includes strategies to enhance emergency preparedness and ensure continuity of care during future crises.
BENAP 2025–2029 is aligned with Bhutan’s 13th Five Year Plan and the National RMNCAH+A strategy (Reproductive, Maternal, Newborn, Child, Adolescent Health and Aging). A strong monitoring and evaluation framework has been embedded, complete with indicators, timelines, and accountable institutions.
Bhutan’s new action plan is more than a technical roadmap. It is a reaffirmation of the country’s enduring promise—to give every mother and every newborn not just a chance to survive, but to thrive.