How Does Bhutan Run its Government and Healthcare System?

Bhutan, a Buddhist nation of just over 750,000 people, is between China and India. After a long period of underdevelopment, with legalized slavery until 1958, Bhutan has dramatically progressed through the course of 12 Five Year Plans (FYPs), currently scheduled through 2023. In 2008, the nation adopted a constitutional monarchy.

Bhutan is famous for its use of the Gross National Happiness Index. Every Five Year Plan discusses what changes the nation must make, as well as what priorities it should adopt, in order to maximize the GNH index. Bhutan’s entire government, along with its healthcare system, runs with the goal of promoting nationwide happiness and well-being. Bhutan utilizes a system of universal free healthcare, which it finances with approximately 3.5% of its GDP. There have been many significant health breakthroughs in Bhutan, between the near-eradication of vaccine-preventable diseases and the provision of an equitable healthcare supply. However, the system has encountered and continues to face several difficulties.

Issues Regarding Healthcare in Bhutan

Modern health struggles have accompanied Bhutan’s modernization; instead of malaria and polio, Bhutan now faces addiction, mental illnesses, HIV/AIDs and other serious problems. Specifically, the three most pressing concerns are systemic healthcare problems, noncommunicable diseases and mental health issues. Bhutan’s healthcare system faces challenges itself. Most prominent is a lack of proper recordkeeping, unequal access to care (despite having equal supply) and inadequate providers.

First, Bhutan does not properly record most of its health difficulties. This lack of data leads to increased difficulty in making progress. The Five Year Plans cannot satisfactorily address problems that the Bhutanese government does not know are occurring. Second, facilities face large discrepancies in their quality of care and certain settlement areas do not receive enough information about the nation’s healthcare options. Just because there is equitable supply does not mean that all in the nation have access to or know to utilize the care that Bhutan’s government provides.

Third, Bhutan employs underqualified healthcare workers. While a lack of reports means that the international community is unaware of the exact problems the Bhutanese population encounters, as well as how many in Bhutan die due to dangerous healthcare, the World Health Organization (WHO) estimates that millions die globally because of unsafe medical care and that around half of these deaths are preventable. A study that the British Medical Journal Open (BMJ) published found that Bhutan’s healthcare system’s most prominent failings have been due to inadequate skills, training and attitudes among providers.

Health Problems in Bhutan

Furthermore, non-communicable diseases account for 53% of all deaths, and they are the leading cause of death across all age groups. Cancer, diabetes and traffic injuries have replaced the falling number of deaths from STIs. Despite working out of a framework dedicated to happiness, Bhutan ranks 20th on a list of countries regarding their rate of suicide. Combined with addiction and other mental health struggles, this is an area where Bhutanese healthcare faces an extreme care deficiency.

Bhutan did not employ its first psychiatrist until 1999 when Bhutan-born and Sri Lanka-trained Dr. Chencho Dorji returned to the nation. As of 2013, the majority of more than 5,300 Bhutanese psychiatric patients have fallen onto the shoulders of Dr. Chencho. As of the 2020 survey, Bhutan only employs 116 in the department of therapy — that is, barely more than 0.015% of its population. To put this number in context, 0.03% of the United State’s population are licensed therapists. Nevertheless, plenty of reasons exist for one to be optimistic about Bhutan’s healthcare system.

Optimism About Bhutan’s Future

Bhutan has multiple ways to resolve the healthcare problems it is currently facing. For example, the BMJ study focused on collaboration, resources and governance, but a better way of looking for optimism could be to investigate what the Five Year Plan prioritizes. Prioritization in the FYPs produced all of Bhutan’s historical healthcare successes, and there is no reason to predict otherwise for current crises. The 12th Five Year Plan, in effect from 2018 to 2023, provides solutions to the struggles of healthcare in Bhutan.

About the 12th Five Year Plan

First, the 12th Five Year Plan addresses problems in data recording as discussed at the 11th FYP’s mid-term review, prioritizing proper data collection for the new term to accurately perceive what problems need attention. Bhutan’s excellent COVID-19 response showcased success in this area. Second, the fight against non-communicable diseases (NCDs) worked its way into the forefront of Bhutan’s healthcare policy and is clearly a priority in the 12th Five Year Plan. Bhutan shares the international goal of eradicating tuberculosis by 2035 and recognizes both cures and treatments of NCDs as a dire need. Third, the FYP expanded from its four pillars of a just society to nine domains. The new domains include living standards, education, health, psychological well-being, cultural resilience, ecological diversity, among others.

The plan accounts for other systemic issues in the Bhutan healthcare system as well. One of the central means of progress that the FYP outlined is decentralization. By allocating funding to local governments to more comprehensively provide care throughout the nation, Bhutan will see a rise in equitable access to care — not just supply. Additionally, the 12th FYP details increased provider training.

Some of the new domains, including creating a charitable culture and regulating time allocation between work, sleep and other activities, work directly to combat mental illness. Psychological well-being places focus on providing adequate treatment to those who are still struggling despite those domains. New policies and priorities outlined in the 12th FYP provide hope for one of the fastest developing healthcare ministries globally.

Looking Ahead

There are certainly kinks in healthcare in Bhutan that the country must work out. However, with the changes in the Five Year Plan, the system of healthcare seems to be leading the way to a very bright future.

The only factor holding back this optimism is Bhutan’s limited resources. But, Bhutan underwent a great economic change, raising its GDP at an annual average of 7.5% just two decades after emancipation. As one of the fastest-growing economies in the world, its health services have seen great progress and continued to grow with time.

If a small, underdeveloped country with a great resource shortage can successfully implement a healthcare system that specifically focuses on its citizens’ happiness, perhaps this system could inspire a seismic shift in the way government runs. Bhutan has set a precedent for designing a world where the population’s happiness is the government’s main priority and, with adequate funding, it could more thoroughly achieve these goals. Now, it is time for the U.S., France, Germany, the U.K. and other global democratic superpowers to step up and do the same.