…amid rising disease burden and digital transformation
RENUKA RAI | Thimphu
Bhutan’s public health system continued to face complex and evolving challenges in 2024, ranging from persistent infectious diseases to pressures on human resources and infrastructure.
This comes even as the country made notable progress in digital health transformation and disease surveillance.
Data from the Annual Health Bulletin 2025 presents a comprehensive picture of the nation’s health landscape, highlighting both achievements and areas requiring sustained attention.
Tuberculosis remains one of Bhutan’s most pressing public health concerns.
Under the Ministry of Health (MoH), the National Tuberculosis Control Programme (NTCP) continues to provide free diagnostic and treatment services nationwide, ensuring access even for communities in remote and hard-to-reach areas.
The programme emphasizes early detection, strict treatment adherence, community awareness, and capacity building of healthcare workers, while working closely with international partners to strengthen health infrastructure.
Despite these efforts, TB continues to pose challenges. In 2024, Bhutan recorded a total of 920 tuberculosis cases, underscoring the continued urgency of prevention and control measures.
Pulmonary tuberculosis accounted for the majority of cases, with about 65 percent of all reported infections falling under this category.
Among these, most were bacteriologically confirmed, reflecting improvements in diagnostic capacity. Relapse cases, including both pulmonary and extrapulmonary TB, were also reported, pointing to ongoing issues related to treatment completion and long-term patient monitoring.
Health officials note that multidrug-resistant TB, treatment non-compliance, and the need for continuous health education remain major obstacles in eliminating the disease.
A closer look at the age distribution reveals that a significant proportion of TB cases occurred among the economically active population.
This trend raises concerns about productivity loss, income insecurity, and increased transmission risk within communities and workplaces.
In response, the MoH is strengthening targeted screening programmes and integrating digital tools for improved diagnosis and patient follow-up, with the long-term goal of achieving a TB-free Bhutan.
Beyond TB, notifiable diseases continued to place a heavy burden on the healthcare system. According to data from the Royal Centre for Disease Control (RCDC), Bhutan recorded over 154,000 cases of notifiable diseases through its weekly reporting system in 2024.
Acute respiratory infections dominated the disease profile, accounting for more than four-fifths of reported cases, followed by acute watery diarrhoea.
Children were the most affected demographic group, highlighting their vulnerability to infectious diseases and the critical need for preventive interventions, including vaccination, nutrition, and sanitation improvements.
In addition to weekly reportable diseases, Bhutan maintains a system for immediate notification of high-risk diseases and syndromes.
In 2024, suspected cases of measles and rubella, malaria, dengue fever, bacterial meningitis, and pertussis were reported through this system.
Laboratory testing confirmed that all suspected measles and rubella samples were negative, reinforcing the effectiveness of Bhutan’s immunisation programme.
Three suspected cases of acute flaccid paralysis were also reported, with all samples testing negative for poliovirus at a reference laboratory in Thailand, reaffirming Bhutan’s continued polio-free status.
The presence of diverse infectious diseases underscores the importance of a robust public health surveillance system.
Health authorities stress that effective disease monitoring, timely reporting, and rapid response mechanisms remain essential to preventing outbreaks and protecting population health.
Bhutan’s response to HIV/AIDS also reflects steady progress alongside emerging challenges. As of December 2024, the country recorded a cumulative total of 1,020 HIV cases since the first detection in 1993.
While 209 deaths have occurred over this period, including 21 in 2024, the number of people living with HIV stands at 774.
Encouragingly, 98 percent of those diagnosed are currently receiving antiretroviral therapy, reflecting strong treatment coverage and programme effectiveness.
In 2024, 85 new HIV cases were detected, continuing a gradual upward trend in new infections.
To strengthen prevention efforts, the National HIV/AIDS and STIs Control Programme introduced Pre-Exposure Prophylaxis (PrEP) as part of its prevention package.
PrEP is currently available to targeted high-risk groups in Thimphu and Paro and is expected to play a key role in reducing new infections.
Bhutan remains aligned with global efforts to achieve the UNAIDS 95-95-95 targets by 2030, aiming to ensure widespread testing, sustained treatment, and viral suppression across all population groups.
Malaria re-emerged as a significant concern in 2024, with Bhutan reporting 144 cases, more than four times the number recorded in the previous year.
Health officials attribute this surge primarily to a major malaria outbreak in neighbouring districts of Assam, India.
The impact was largely confined to border areas, demonstrating the effectiveness of Bhutan’s real-time surveillance and rapid response systems.
Most cases were classified as imported or introduced, with no evidence of indigenous transmission, an important milestone in the country’s malaria elimination efforts.
The majority of cases were caused by Plasmodium vivax, a form of malaria known for its relapsing nature.
Men accounted for nearly three-quarters of infections, largely due to occupational exposure among border security personnel, farmers, and forestry workers.
The most affected age group was 15 to 49 years, reflecting increased mobility and cross-border movement.
Health authorities emphasize the need for sustained cross-border collaboration, targeted interventions for high-risk groups, and continued public awareness to prevent further spread.
While disease surveillance and control remain critical, the health workforce forms the backbone of Bhutan’s healthcare system.
Over the past five years, the country has seen a steady increase in the number of doctors, rising from 336 in 2020 to 411 in 2024.
This growth has improved physician density and expanded access to specialized care.
The integration of traditional medicine has also gained momentum, with increases in the number of Drungtshos and sMenpas, reflecting Bhutan’s commitment to a holistic health system.
However, challenges persist. The number of nurses declined slightly in 2024, and the reduction in health assistants raises concerns about primary healthcare delivery, particularly in rural and underserved areas.
Health officials acknowledge the need for targeted recruitment and retention strategies to ensure frontline services remain strong.
Health infrastructure continues to expand, supporting service delivery across the country. Bhutan now has 59 hospitals, including specialized referral facilities, along with 193 primary health centres and numerous sub-posts.
Outreach clinics play a vital role in reaching remote communities, ensuring that basic healthcare services remain accessible even in geographically challenging areas.
One of the most significant developments in Bhutan’s health sector is the nationwide rollout of the Electronic Patient Information System integrated with the World Health Organization’s ICD-11 classification.
Launched in phases since late 2024, this system marks a major leap in health information management.
More than 1,300 healthcare providers have been trained, enabling real-time disease coding, improved data accuracy, and stronger surveillance capabilities.
Despite challenges such as internet connectivity and varying digital literacy, early results show improved diagnostic precision and greater confidence among healthcare workers.
Complementing this digital transformation is the revitalization of the Annual Household-Health Surveillance.
Fully digitized and integrated into the national DHIS2 platform from 2025, the surveillance covers all households across Bhutan.
By shifting from a one-time survey approach to continuous surveillance, the programme hopes to strengthen community-level monitoring, health advocacy, and evidence-based planning.
