𝐍𝐞𝐰 𝐇𝐞𝐚𝐥𝐭𝐡 𝐁𝐮𝐥𝐥𝐞𝐭𝐢𝐧 𝐇𝐢𝐠𝐡𝐥𝐢𝐠𝐡𝐭𝐬 𝐒𝐭𝐫𝐞𝐧𝐠𝐭𝐡𝐬 𝐢𝐧 𝐒𝐲𝐬𝐭𝐞𝐦𝐬, 𝐆𝐚𝐩𝐬 𝐢𝐧 𝐎𝐮𝐭𝐜𝐨𝐦𝐞𝐬

…𝒇𝒊𝒏𝒅𝒊𝒏𝒈𝒔 𝒑𝒐𝒊𝒏𝒕 𝒕𝒐 𝒔𝒕𝒓𝒐𝒏𝒈 𝒊𝒏𝒔𝒕𝒊𝒕𝒖𝒕𝒊𝒐𝒏𝒂𝒍 𝒄𝒐𝒗𝒆𝒓𝒂𝒈𝒆, 𝒏𝒆𝒂𝒓-𝒖𝒏𝒊𝒗𝒆𝒓𝒔𝒂𝒍 𝒊𝒎𝒎𝒖𝒏𝒊𝒛𝒂𝒕𝒊𝒐𝒏 𝒂𝒏𝒅 𝒐𝒏𝒈𝒐𝒊𝒏𝒈 𝒓𝒊𝒔𝒌𝒔 𝒇𝒓𝒐𝒎 𝒕𝒐𝒃𝒂𝒄𝒄𝒐-𝒓𝒆𝒍𝒂𝒕𝒆𝒅 𝒊𝒍𝒍𝒏𝒆𝒔𝒔 𝒂𝒏𝒅 𝒊𝒎𝒑𝒐𝒓𝒕𝒆𝒅 𝒊𝒏𝒇𝒆𝒄𝒕𝒊𝒐𝒏𝒔

By Yeshi Dolma

In an era of rising global health risks, national health indicators represent more than statistical outcomes¬- they mirror a country’s capacity to protect and serve its population. Bhutan’s latest Annual Health Bulletin offers a detailed view of the health sector’s condition in 2024, framed through the Sustainable Development Goals, health equity, and digital transformation. These indicators bring into focus both the achievements and persistent challenges that shape the nation’s public health efforts.

The Health Minister, Tandin Wangchuk, said the Annual Health Bulletin 2025 plays a crucial role in shaping evidence-based policy. “Major digital reforms such as the transition to a fully digital Health Management Information System through DHIS2, the implementation of ICD-11, and the rollout of the electronic Patient Information System under the Digital Drukyul Flagship are transforming how we monitor, document, and deliver healthcare,” he said. He added that these systems are improving data quality, disease surveillance, and service delivery, and that digital tools will be central to achieving universal health coverage.

Tuberculosis continues to be a public health priority. The National Tuberculosis Control Program provides free diagnostic and treatment services, with strategies focusing on early detection, adherence to treatment, community awareness, and capacity building among healthcare workers. In collaboration with global partners, the program works to address challenges such as multi-drug resistance and treatment non-compliance. The TB notification rate decreased from 126 per 100,000 population in 2020 to 116.97 in 2022, and slightly rose to 112.16 in 2023. A total of 920 TB cases were reported in 2024, of which 65 percent or 598 cases were pulmonary TB. Among them, 552 were bacteriologically confirmed, while 19 were clinically diagnosed. There were 38 cases of pulmonary TB relapse and 17 cases of extrapulmonary TB relapse. Most cases occurred within the economically active age group, with a higher prevalence among men.

These trends mirror global patterns. In China, TB remains a challenge, influenced by high rates of tobacco use. As of 2025, over 25 percent of adults in China were daily smokers, and global studies have linked smoking to a higher risk of TB. Bhutan’s national data reveals a similar correlation. In 2022, the current smoking rate stood at 14.2 percent, with 31.4 percent of people aged 15 to 69 reporting tobacco use. Men, who form the majority of smokers, also represent most TB cases. In this context, recent tobacco control measures such as stricter rules on sales, packaging, and designated smoking areas also serve as disease prevention strategies.

The total number of HIV cases reached 1,020 by the end of 2024, with 209 deaths since the first detection of the virus in the country. In 2024 alone, 85 new cases were confirmed, including nine among individuals aged 15 to 24. Antiretroviral therapy coverage reached 98 percent among people living with HIV. Pre-exposure Prophylaxis was introduced in high-risk districts to prevent transmission, aligning with the UNAIDS 95–95–95 targets for 2030: 95 percent of those infected should know their status, 95 percent of diagnosed individuals should receive sustained treatment, and 95 percent of those treated should achieve viral suppression.

Malaria cases increased significantly to 144 in 2024, more than four times the total in 2023. The rise was linked to an outbreak in neighbouring Indian districts, affecting communities along the border. Of the reported cases, 71 were imported, including 30 non-nationals. The remaining 73 were introduced locally via mosquito transmission triggered by imported infections. Notably, there were no indigenous malaria cases reported. This outcome supports the Sustainable Development Goal Indicator 3.3.3, which only considers indigenous cases in evaluating progress toward zero malaria incidence. Most infections were caused by Plasmodium vivax and were concentrated among working-age males engaged in occupations such as farming, forestry, and border security.

Maternal health indicators in 2023 showed a decline in the maternal mortality ratio to 53 per 100,000 live births, already meeting the target of fewer than 70. Skilled birth attendance reached 98.5 percent in 2024, and institutional deliveries remained high at 98 percent. Child health also showed improvement, with the under-five mortality rate falling to 19.5 per 1,000 live births in 2024. The neonatal mortality rate dropped from 21 in 2021 and 2022 to 6.9 in both 2023 and 2024, a significant reduction in one of the most sensitive indicators of healthcare quality.

Access to health facilities continued to improve, with nearly 97 percent of the population able to reach a health centre within two hours in 2024. Routine immunization remained near-universal, with 99.4 percent of children receiving core vaccines, including those for tuberculosis and measles. The number of medical professionals has steadily increased. In 2020, there were 336 medical doctors, or approximately 4.6 per 10,000 people. By 2024, the number rose to 411, or 5.3 per 10,000. The number of nurses remained stable at 1,572, equating to around 20 per 10,000 population. Pharmacists increased from 42 in 2020 to 48 in 2024. There were also 574 Health Assistants working across the country.

Traditional medicine continues to be integrated into healthcare delivery. The practice of Sowa Rigpa and other indigenous systems are increasingly incorporated into primary healthcare services. Access to improved drinking water sources exceeded 99 percent from 2020 to 2024. Improved sanitation coverage increased from 94.6 percent in 2021 and 2022 to 99.3 percent in 2023 and 2024. These improvements in water and sanitation have contributed to the reduction of diseases such as cholera, parasitic infections, and diarrhoeal illness.

Despite progress, some health challenges remain. The suicide mortality rate stood at 2.3 per 100,000 population. The road traffic fatality rate reached 11.05 deaths per 10,000 registered vehicles. Mental health concerns, substance abuse, and non-communicable diseases are emerging areas of concern. However, the availability of essential medicines in 97 percent of health facilities and efforts to reduce air pollution reflect a broader shift toward preventive public health.

The 2025 Annual Health Bulletin highlights measurable progress across multiple health indicators, especially in maternal and child health, digital health reform, and service accessibility. While the burden of tuberculosis and the surge in malaria cases signal areas that require sustained attention, policy decisions grounded in data, combined with digital systems and improved infrastructure, are contributing to early gains on the path to the 2030 Sustainable Development Goals. National comparisons with larger countries in the region highlight shared risk factors such as tobacco use, reinforcing the significance of integrated, preventive public health strategies.