𝐍𝐚𝐧𝐨𝐧𝐠 𝐁𝐇𝐔 𝐎𝐩𝐞𝐫𝐚𝐭𝐞𝐬 𝐖𝐢𝐭𝐡 𝐒𝐢𝐧𝐠𝐥𝐞 𝐇𝐞𝐚𝐥𝐭𝐡 𝐀𝐬𝐬𝐢𝐬𝐭𝐚𝐧𝐭 𝐖𝐡𝐢𝐥𝐞 𝐆𝐨𝐦𝐭𝐮 𝐋𝐚𝐜𝐤𝐬 𝐃𝐨𝐜𝐭𝐨𝐫

…𝒄𝒐𝒎𝒎𝒖𝒏𝒊𝒕𝒊𝒆𝒔 𝒔𝒕𝒓𝒖𝒈𝒈𝒍𝒆 𝒘𝒊𝒕𝒉 𝒍𝒊𝒎𝒊𝒕𝒆𝒅 𝒂𝒄𝒄𝒆𝒔𝒔 𝒕𝒐 𝒉𝒆𝒂𝒍𝒕𝒉𝒄𝒂𝒓𝒆 𝒂𝒔 𝒉𝒆𝒂𝒍𝒕𝒉 𝒂𝒔𝒔𝒊𝒔𝒕𝒂𝒏𝒕𝒔 𝒎𝒂𝒏𝒂𝒈𝒆 𝒎𝒖𝒍𝒕𝒊𝒑𝒍𝒆 𝒔𝒆𝒓𝒗𝒊𝒄𝒆𝒔 𝒂𝒍𝒐𝒏𝒆

By Sonam Choden

Almost two years after staffing shortages were first reported at Nanong Basic Health Unit (BHU) and Tsatsi Primary Health Care (PHC) in Pemagatshel, the facilities continue to operate with only one Health Assistant (HA), leaving the community with limited access to healthcare. In Samtse, Gomtu Hospital has been functioning without a doctor since July 4, 2025, forcing residents of the industrial town to rely solely on a HA. Both cases highlight ongoing challenges in the healthcare delivery system, despite constitutional commitments to free basic healthcare for all.

At Tsatsi PHC, the HA reported attending 15 to 20 patients per day on average. With no additional staff to support her, she manages all services alone. She explained, “This situation is challenging, especially during periods of illness or leave. At times, I have to temporarily close the facility, which disrupts access to healthcare for the community.”

In Gomtu Hospital, which serves 705 registered households, approximately 1,200 people, the absence of a doctor has resulted in a similarly overwhelming workload. The HA stated, “In a day I receive around 70 Outpatient Department (OPD) patients and around 20 Maternal and Child Health (MCH) patients.” Cases requiring advanced medical intervention are referred to Samtse Hospital. She further described her routine: “I have to first take care of the OPD and then attend MCH patients afterwards, which results in running back and forth throughout the day, making the workload very hectic.”

The industrial profile of Gomtu further complicates healthcare delivery. The town hosts cement factories and other high-risk workplaces, increasing the likelihood of accidents. Robat Lepcha, Gup of Phuntshopelri Gewog, noted, “Gomtu is an industrial area with factories and high-risk work environments. Accidents can happen anytime, and having only a HA without a doctor is a serious risk to public health.”

Staffing shortages at Gomtu also affect nearby chiwogs. Som Bdr Ghalley, Tshokpa of Gashingma, reported that their chiwog maintains a sub-post; however, the HA is occasionally required to attend to Gomtu due to the absence of a doctor, disrupting services locally. He noted, “If we have a private car, it is manageable because we can travel to Samtse. But without a car, we have to take a taxi, which costs Nu. 1,000, and that is quite expensive.”

The absence of an ambulance further exacerbates challenges for Nanong residents, who must travel long distances to higher referral centers during emergencies. The staffing gap is not due to a lack of trained personnel. The Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) graduated 15 Health Assistants in June 2025, and the 2026 intake has been increased to 30 trainees. Yet, according to HAs, no new staff have been deployed to Nanong or Tsatsi, and there has been no official communication regarding reinforcements. This delay illustrates the gap between national-level policy planning and field-level implementation.

The Ministry of Health has stated that staffing will be assessed based on actual demand and available resources, and the 13th Five Year Plan prioritizes strengthening human resources for health. However, rural and high-risk areas continue to face delays and uncertainty. Article 9, Section 21 of the Constitution of Bhutan states, “The State shall provide free access to basic public health services in both modern and traditional medicines.”

Staffing shortages reflect broader inequities in the healthcare system. While urban centers and referral hospitals have relatively better staffing and facilities, remote communities face a double burden: challenging geography and limited workforce deployment. Health Assistants, who form the backbone of the primary healthcare system, are often stretched beyond capacity.

Residents and community leaders have appealed to authorities for support. Letters have been sent to the Dzongdag and Members of Parliament, but no response has been received. Communities stress that their demands are not for advanced services but for basic reliability: a functioning health center with adequate staff, ambulance services, and assurance that emergencies can be managed locally. Timely staffing and proper deployment would reduce the burden on referral hospitals and prevent avoidable deaths.

As Nanong approaches its second year of operating with only one HA, and Gomtu enters its third month without a doctor, calls for urgent intervention are growing. Until concrete measures are taken, frontline workers will continue to shoulder disproportionate responsibility, and vulnerable communities will remain underserved, unable to fully access timely and adequate healthcare.