Bhutan faces emerging health challenges with a shifting burden towards noncommunicable diseases and an aging population. The country continues to address high rates of malnutrition and disparities in access to maternal and child health services. To respond to these evolving challenges and develop a more resilient health system, the Royal Government of Bhutan has partnered with the World Bank to assess the current status and identify strengths and opportunities within the existing primary health care (PHC) system.
The Ministry of Health of Bhutan, supported by funding from the Government of Japan and The Global Fund, undertook four comprehensive assessments. This initiative marked Bhutan as a pioneer in primary healthcare measurement within South Asia. These assessments delve into Bhutan’s healthcare system, identifying strengths, weaknesses, and opportunities for growth.
The Primary Health Care Performance Initiative (PHCPI) report highlights Bhutan’s PHC system's strengths and gaps. It forms the foundation for actionable policy recommendations aimed at bolstering the nation's healthcare system. The Service Delivery Indicators (SDI) health survey measures key primary health care domains in Bhutan, including workforce, policies, management processes of care, patient experiences, user confidence in the system, and personal medical costs.
The Bhutan Healthcare Costing Analysis assesses the cost of delivering health services at various facilities over time. The Issue Brief Series on Sustainable Health Financing in Bhutan identifies financing efficiency and sustainability as key emerging challenges while underscoring the importance of investing in primary health care to improve value for money.
“The SDI survey not only provides critical insights into the quality of health service delivery in the country; it is also very timely for the 13th Five-Year Plan baseline,” said Lyonpo Tandin Wangchuk, Honorable Minister at the Ministry of Health.
While there has been progress in PHC service delivery, persistent challenges remain:
Patient satisfaction: Patients are highly satisfied with their primary health care; 95% rate facility quality as good or very good but express dissatisfaction with travel time to facilities and wait times before being seen by providers.
Infrastructure availability: Electricity and water access are near universal but often interrupted. Only 11% of facilities had uninterrupted electricity; 39% had uninterrupted water supply over three months prior to the survey. Internet connectivity exists at 70% of facilities but is uninterrupted at only 17%. Less than 25% have ramps; 13% have handicap-accessible toilets; only 23% have fire extinguishers; less than 3% have fire alarms/smoke detectors.
Service availability: There is broad availability for most high-priority maternal/child health services and noncommunicable diseases but limited readiness for emergent priorities like cervical cancer screening, mental health services, detoxification/rehabilitative services especially at primary facility levels.
Primary healthcare workforce issues: Nearly all providers find their work meaningful yet face dissatisfaction with administrative burdens, growth opportunities, work demands—particularly among doctors.
Diagnostic/treatment accuracy: In clinical simulations from SDI surveys: childhood diarrhea/pneumonia diagnosis accuracy was 98%, childhood stunting was 69%, intrapartum emergency cases were poorly managed comprehensively; depression diagnosis accuracy was lowest at 64%.
Continuity of care: Only 40% reported usually receiving care at same facility; 21% bypassed more convenient facilities seeking specialized services elsewhere.
“Bhutan has always placed a strong emphasis on primary healthcare's importance," said Tashi Penjor Chief Policy & Planning Division Ministry Of Health "Much success attributed strong foundation dynamism current PHCPI SDI financing assessments timely check urgency align importance accorded PHC foundation strong system."
As Bhutan charts its healthcare future collaboration innovation remain paramount A two-day action-oriented workshop convened last month by Ministry Of Health supported World Bank served catalyst change Stakeholders across converged review assessment findings engage dialogue strategically integrate futures thinking chart course long-term vision