TIL BDR GHALLEY| Thimphu
A review conducted by the Economic Affairs Committee (EAC) of the National Council presented their review report on the health care system in Bhutan on 12 December 2025 at the National council ongoing session.
The Chairperson of EAC, Tshewang Rinchen, introduced the report, outlining key observations, challenges, and recommendations aimed at strengthening the country’s overall healthcare delivery.
The review report has identified persistent structural, operational, and human resource challenges within Bhutan’s healthcare system, even as the country continues to provide free and universal health services nationwide.
The review examined healthcare delivery at national, regional, district, and primary healthcare levels, including referral hospitals, regional referral hospitals, district hospitals, Basic Health Units (BHUs), and outreach clinics.
According to the report, Bhutan has achieved nationwide healthcare coverage through an extensive network of referral hospitals, district hospitals, Basic Health Units (BHUs), and outreach clinics. However, disparities remain in service quality, availability of diagnostic facilities, and access to specialist care, particularly between urban referral hospitals and peripheral health centres.
At the national level, the review found that national referral hospital (JDWNRH) continues to face sustained pressure due to high patient inflow from across the country. Congestion was reported in outpatient departments, diagnostic services, and inpatient wards, driven by referrals from districts and patients bypassing lower-level facilities. Shortages of specialist doctors, nurses, and allied health professionals were identified as contributing factors affecting patient waiting time and service efficiency.
Regional referral hospitals, including the central regional referral hospital in Gelephu, the eastern regional referral hospital in Mongar, and the national referral hospital in Thimphu, were also assessed. The review noted that while these hospitals have benefited from infrastructure expansion and service upgrades, gaps persist in specialist services, diagnostic capacity, and technical manpower. In some facilities, advanced medical equipment was reported to be underutilized due to the absence of trained personnel or regular maintenance support.
The review further highlighted variations in service capacity among district hospitals. Several district hospitals were found to face challenges in emergency care services, laboratory diagnostics, and operation theatre functionality. Staffing shortages, particularly of doctors, nurses, and laboratory technicians, were reported to affect continuity of care. The report also noted that accommodation and working conditions for health workers in remote districts remain a concern, influencing deployment and retention.
At the primary healthcare level, BHUs and outreach clinics were recognized as essential components of Bhutan’s healthcare delivery system, particularly for rural and remote communities. While these facilities play a critical role in preventive care and early treatment, the review found challenges related to infrastructure maintenance, availability of essential medicines, and transport support for outreach services. Difficult terrain and limited staff housing were cited as factors affecting service provision in certain locations.
Human resource constraints emerged as a cross-cutting issue across all levels of the healthcare system. The report identified shortages of specialist doctors, general physicians, nurses, midwives, pharmacists, laboratory technicians, and biomedical engineers. High workload, frequent transfers, limited career progression opportunities, and retention challenges were cited as contributing factors. The review also noted uneven deployment of health workers, with referral hospitals carrying a higher concentration of professionals while primary and secondary facilities face staffing gaps.
The availability and functionality of medical equipment were also examined. According to the report, inconsistencies exist in equipment maintenance and utilization across health facilities. Some hospitals were reported to have diagnostic machines that were either non-functional or operating below capacity due to a lack of trained operators or technical support, affecting timely diagnosis and treatment.
In terms of pharmaceuticals, the review pointed to recurring shortages of essential medicines and medical supplies in some facilities. Procurement delays, forecasting gaps, logistical challenges, and storage limitations were identified as key factors affecting timely availability. The Committee also noted concerns related to wastage resulting from medicine expiry and inefficiencies in centralized procurement processes.
While Bhutan maintains a policy of free healthcare, the EAC raised concerns about long-term financial sustainability. Rising healthcare costs, an increasing burden of non-communicable diseases, growing demand for advanced treatments, and rising expenditure on overseas medical referrals were identified as major pressures on the national health budget. The report noted that spending on high-end medical care and referrals abroad has increased in recent years.
The review also highlighted challenges related to medical education and workforce development. Limited intake capacity, dependence on overseas training, and constraints in specialized training programs were identified as factors affecting workforce sustainability. The Committee emphasized the importance of aligning medical education and continuous professional development programs with national healthcare needs.
In addition, the report identified gaps in healthcare governance, monitoring, and data management systems. Fragmented health data, limited integration of digital health systems, and weak monitoring mechanisms were found to affect evidence-based planning and decision-making. The Committee underscored the need for stronger coordination among relevant agencies and improved accountability frameworks.
The EAC review emphasizes that while Bhutan’s healthcare system continues to provide broad access to services nationwide, persistent challenges remain in human resources, infrastructure, equipment functionality, referral efficiency, and financial sustainability. The Review Report has been submitted to the House for deliberation, with the Committee calling for coordinated and timely action by relevant ministries and agencies to address the identified gaps.
