𝐇𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐒𝐲𝐬𝐭𝐞𝐦 𝐅𝐚𝐜𝐞𝐬 𝐆𝐫𝐨𝐰𝐢𝐧𝐠 𝐏𝐫𝐞𝐬𝐬𝐮𝐫𝐞 𝐅𝐫𝐨𝐦 𝐖𝐨𝐫𝐤𝐟𝐨𝐫𝐜𝐞 𝐒𝐡𝐨𝐫𝐭𝐚𝐠𝐞𝐬 𝐀𝐧𝐝 𝐑𝐢𝐬𝐢𝐧𝐠 𝐑𝐞𝐟𝐞𝐫𝐫𝐚𝐥 𝐂𝐨𝐬𝐭𝐬

…𝒓𝒆𝒑𝒐𝒓𝒕 𝒉𝒊𝒈𝒉𝒍𝒊𝒈𝒉𝒕𝒔 𝒈𝒂𝒑𝒔 𝒊𝒏 𝒔𝒕𝒂𝒇𝒇 𝒅𝒊𝒔𝒕𝒓𝒊𝒃𝒖𝒕𝒊𝒐𝒏, 𝒊𝒏𝒇𝒓𝒂𝒔𝒕𝒓𝒖𝒄𝒕𝒖𝒓𝒆, 𝒂𝒏𝒅 𝒔𝒑𝒆𝒄𝒊𝒂𝒍𝒊𝒔𝒆𝒅 𝒄𝒂𝒓𝒆 𝒘𝒉𝒊𝒍𝒆 𝒓𝒆𝒄𝒐𝒎𝒎𝒆𝒏𝒅𝒊𝒏𝒈 𝒄𝒐𝒎𝒑𝒓𝒆𝒉𝒆𝒏𝒔𝒊𝒗𝒆 𝒑𝒐𝒍𝒊𝒄𝒚 𝒓𝒆𝒇𝒐𝒓𝒎𝒔

By Kinzang Lhamo

The health ealthcare system is under increasing pressure from acute human resource shortages, rising patient referral costs, and persistent infrastructure gaps, according to the Review Report on the Healthcare System in Bhutan presented by the Economic Affairs Committee (EAC) during the National Council’s 12th sitting.

The report noted that while physical access to health facilities remains largely intact, “the quality of care is increasingly strained by high attrition rates, overburdened staff, and rising service demands.” Based on nationwide assessments of national referral hospitals and Basic Health Units, the committee identified human resource shortages as the most pressing challenge.

The report stated, “The system faces a shortage of 1,576 health professionals, including 730 nurses, with uneven deployment further exacerbating service gaps.” Attrition among critical staff reached 11.25 percent as of January 2024, while the total health workforce of 6,891 remains below the estimated requirement. The Royal Civil Service Commission reports that only 4,153 civil servants are employed in the Medical and Health Services group, against a requirement of more than 10,000.

Despite nation’s relatively high public health expenditure of 3.4 percent of GDP, among the highest in South Asia, workforce density remains below World Health Organization benchmarks. The doctor-to-population ratio stands at 5.29 per 10,000 people, and the nurse-to-population ratio at 20.2, while the number of Health Assistants declined from 650 in 2020 to 580 in 2023, affecting primary healthcare delivery.

Infrastructure constraints further affect service delivery, particularly in remote areas. The report highlighted that “unreliable electricity supply, water shortages, and limited internet connectivity continue to undermine effective service delivery across health facilities.”
Weak compliance with referral protocols has contributed to overcrowding at tertiary hospitals. “Inadequate adherence to referral protocols has led to congestion in tertiary hospitals, placing additional pressure on limited specialist services,” the report notes.

These gaps have coincided with a sharp rise in government spending on overseas patient referrals. Ex-country referral costs increased from Nu. 214 million in the 2021-22 fiscal year to Nu. 730 million in 2024-25, reflecting ongoing shortfalls in specialised care and diagnostic capacity. The report noted, “The significant increase in referral expenditure reflects persistent gaps in specialised care and diagnostic capacity within the country.”

The review situates these challenges within broader demographic and epidemiological transitions. Bhutan’s population, estimated at 784,043, is ageing rapidly due to declining fertility and increased life expectancy. The proportion of people aged 65 and above is projected to rise from 6.6 percent in 2022 to 13.4 percent by 2047, doubling the old-age dependency ratio. The report cautioned that “this shift will substantially increase demand for healthcare and social services.”

Noncommunicable diseases now dominate the country’s disease burden. The report highlighted that the share of NCDs rose from 23 percent in 1990 to 62 percent in 2019, with 41 percent of total health expenditure in 2019-20 linked to NCD-related conditions. Nearly 10 percent of admissions in referral hospitals are attributed to such diseases, while mental health conditions, including anxiety, depression, and substance use disorders, were also flagged as rising concerns.

To address these challenges, the EAC recommended a set of structural and policy reforms. Central among them is the enactment of a dedicated National Healthcare Act. The report stated, “The Committee recommended the enactment of a National Healthcare Act to establish a strong legal foundation for governance, quality assurance, and patient protection.”

Other recommendations include introducing a differentiated and autonomous health workforce management system, reforming procurement processes to prioritise quality over lowest cost, accelerating digitalisation, upgrading infrastructure, and strengthening preventive and curative healthcare services.

The report aligns with the priorities of the 13th Five Year Plan, under which the Ministry of Health has allocated Nu. 19.125 billion for the Healthy Drukyul Program, aimed at improving population health and wellbeing. Following the introduction of the report during the 12th sitting, Members of the National Council continued deliberations, raising concerns over workforce shortages, high nurse attrition, uneven distribution of health personnel, infrastructure deficiencies, and increasing workload pressures across health facilities. Members broadly supported recommendations related to strengthening health policy, improving human resource planning, enhancing digital health systems, and reforming healthcare governance.

On procurement processes, retention of health professionals, and strengthening specialised healthcare services, Members made additional submissions, prompting the Committee to revisit these areas in consultation with concerned Members.

During the 16th sitting of the 36th Session, the House adopted all seven recommendations proposed by the Committee, along with an additional measure allowing the private sector to operate selected non-essential healthcare services to complement government provision. The recommendations were adopted with 22 votes in favour and one abstention.

The report provides comprehensive data on workforce, infrastructure, referral costs, and disease burden, which will guide future policy direction, strategic planning, and resource allocation in the nation’s health sector.