Jigmi Wangdi

Addressing disparities in access, service utilisation, and health outcomes between urban and rural areas is crucial for achieving equity in the healthcare system, which requires comprehensive policy attention, especially considering ongoing resource challenges and the impact of the Covid-19 pandemic.

This is according to the Primary Health Care Performance Initiative Assessment (PHCPI).

To assess the strengths and weaknesses of Bhutan’s primary healthcare system and formulate actionable policy recommendations to improve the system, the World Bank, in collaboration with the Ministry of Health, conducted the PHCPI. 

The study also stated that Bhutan’s PHC system has a clear organisation and service delivery structure based on health facility catchment zones. However, migration from rural to urban areas has led to overcrowding in urban hospitals and underutilisation of health facilities in rural areas.

The report also highlighted that there are opportunities to strengthen the capacity of the PHC system to deliver high-quality care, address emerging challenges such as NCDs and mental health, and improve pandemic preparedness.

The report recommends investing in enhancing the availability, competencies, and satisfaction of healthcare workers, including promoting equitable distribution, availability, and competencies of healthcare workers, and strengthening the village health worker programme. 

Health Economist at the World Bank in South Asia, Kathryn Andrews, who led the study, said that one of the most important takeaways from the PHCPI was that strategic investments and health care in Bhutan had resulted in a strong PHC system in Bhutan.

“Bhutan’s commitment to providing free health services at the point of care along with efforts to improve health system governance has provided a very strong foundation for PHC. There has been measurable progress and population health and health service provision and the National Happiness policy set a strong foundation for underlying primary care,” Kathryn said. 

Kathryn noted that there have been improvements in key reproductive, maternal, and child health indicators, as well as in life expectancy. However, she highlighted the concerning trend of rising non-communicable diseases and mental health conditions in Bhutan and globally.


To enhance the primary healthcare system in Bhutan, the report emphasised several critical issues that need attention.

One recommendation is to use digital health solutions to enhance the quality and efficiency of primary healthcare in Bhutan. This, according to the report, can be achieved by improving the capabilities of data platforms to enhance service delivery and patient experience. Establishing a national-level telehealth programme is also expected to improve equitable access to care and the efficiency of service provision.

The report underscores the importance of investing in the capacities of the primary healthcare system to enhance its quality and effectively address emerging challenges, including non-communicable diseases (NCDs), mental health issues, and pandemic preparedness. 

This involves strengthening the availability of essential resources to ensure equitable access and safe service delivery. Additionally, introducing a systematic monitoring and evaluation framework for quality standards is crucial for ensuring continuous improvement.

Another recommendation from the report is to invest in improving the availability, competencies, and satisfaction of healthcare workers. This can be achieved by promoting equitable distribution and availability of healthcare workers through recruitment and retention efforts. 

Providing timely incentives and support is expected to further enhance their satisfaction and motivation.