The Bhutanese Leading the way.
During the 12th Sitting of the National Council (NC), the Economic Affairs Committee (EAC) presented a review report of Bhutan’s healthcare system, noting both its remarkable growth and the challenges it now faces.
From its beginnings in 1961 with just two hospitals, two doctors, and two nurses, Bhutan’s health sector has expanded into a comprehensive system providing free healthcare to all citizens. However, rising financial pressures now challenge its sustainability.
A key concern is the dual burden of infectious diseases, such as tuberculosis, HIV, malaria, and dengue, and the rapidly increasing prevalence of non-communicable diseases (NCDs).
According to the EAC’s report, NCDs accounted for 41 percent of total health expenditures in 2019-2020 and nearly 10 percent of admissions in referral hospitals. The national disease burden from NCDs has risen from 23 percent in 1990 to 62 percent in 2019, placing a significant strain on limited resources.
The Chairperson of EAC, Tshewang Rinchen, highlighted that Bhutan’s public health expenditure stands at 3.4 percent of GDP, the highest in South Asia, while out-of-pocket costs remain among the lowest in the region.
Despite this strong public investment, rising expectations, an aging population, and the demand for chronic care continue to pressure the system.
Under the 13th Five-Year Plan, the Ministry of Health allocated Nu 19.12 billion for the “Healthy Drukyul Program,” aimed at strengthening service delivery and addressing growing health needs. However, the EAC noted that ensuring equitable and sustainable healthcare remains a challenge.
According to the findings shared by the committee, Bhutan faces significant human resource constraints. The doctor-to-population ratio is 5.29 per 10,000 people, and the nurse-to-population ratio is 20.22 per 10,000, both below WHO recommendations.
The number of Health Assistants, essential for rural primary care, has declined from 650 in 2020 to 580 in 2023. While the sector requires over 10,000 personnel, the actual workforce stands at only 6,891, with a 6.4 percent attrition rate as of September 2025 due to further studies or employment abroad.
EAC also highlighted misalignments in the human resources framework. The Chairperson said, “The nurse intake in 2025 is capped at 650, leaving a shortfall of 730 nurses.”
Moreover, the diploma-trained nurses have limited opportunities to pursue Bachelor of Science degrees, and staff in high-burnout areas, such as emergency and gynecology, lack incentives.
EAC further notes that workforce shortages, inflexible career pathways, and inadequate recognition of specialization worsen attrition and retention challenges. EAC further highlighted that the infrastructure gaps further impact healthcare delivery. Regulations prioritizing cost over quality often result in substandard facilities and equipment.
The report notes that many hospitals lack basic infrastructure for safe patient care, and complex procurement processes delay services. Additionally, limited financial autonomy for National Medical Services prevents timely operational responses.
The Chairperson said, “Primary healthcare has expanded, yet access to care remains limited, with one doctor serving nearly 1,921 people in 2023, and hospital bed availability declining from 23 to 21 per 10,000 people.”
Critical gaps include uninterrupted electricity (11 percent of facilities), water supply (39 percent), stable internet (17 percent), accessibility for persons with disabilities, and fire safety measures.
EAC emphasized that Bhutan lacks a binding legislative framework to ensure quality standards, patient rights, and health worker protections. The Chairperson recommended considering a National Healthcare Act, similar to the UK’s Health and Care Act 2022, to secure sustainable financing and a resilient system.
According to the research done by EAC, the health workforce has seen growth in some categories: Specialists increased from 119 in 2020 to 207 in 2025, Medical Officers from 217 to 234, Clinical Counselors from 6 to 24, and EMRO/EMT staff from 43 to 98. Conversely, Health Assistants declined from 650 to 574, and Medical Technologists from 219 to 145.
Traditional medicine specialists and dental specialists have increased, reflecting shifts in clinical capacity.
However, the report shows a 26.4 percent staffing deficit, with a shortfall of 1,576 professionals, most severe among nurses, who are 730 below the approved standard.
Contract hires, expatriate specialists, and long-term training programs partially address gaps, but high attrition continues to challenge retention.
According to the report, nursing intake has increased from 230 in 2021 to 650 in 2025, supplemented by foreign nurse recruitment, yet training expansion must continue to fill the gap.
The report states that the patient referrals, particularly for specialized treatments abroad, highlight further strain. The report states, “The data on patient referral costs reveals expenditures tripling from Nu. 214 million in 2021-2022 to Nu. 730 million in 2024-2025.”
The Chairperson said, “Cancer referrals rose from 134 to 410, kidney referrals from 21 to 52, and neurology referrals increased to Nu 147.50 million in costs between June 2024 and June 2025.”
The report on the budget allocation highlights that Bhutan’s health sector budget has steadily grown, doubling from Nu 6.44 billion in 2020-2021 to Nu 12.91 billion in 2025-2026, maintaining a 9-12.9 percent share of the national budget.
The peak allocation in 2022-2023 reflected post-pandemic reinforcement, while the 2025-2026 budget emphasizes long-term infrastructure development, with the highest capital expenditure of Nu 4.9 billion.
According to EAC, the Healthy Drukyul Programme’s budget targets governance improvement, preventive and promotive care, and rationalization of facilities. However, gaps in human resources, digital infrastructure, specialized services, and referral mechanisms limit the program’s full potential.
Based on its review, EAC recommended strengthening legislative support, realigning HR policies with healthcare needs, improving infrastructure procurement and maintenance, clarifying governance, and addressing workforce gaps through better incentives, career pathways, and retention strategies. Moreover, the committee notes that strategic domestic capacity building is also essential to reduce costly patient referrals abroad and ensure equitable, cost-effective healthcare delivery.
