From 35 percent to 73 percent in twenty-four years

In 2000, non-communicable diseases — diabetes, hypertension, heart disease, stroke, cancer, chronic kidney disease, chronic obstructive pulmonary disease — caused 35 percent of all Bhutanese deaths. The other 65 percent were infectious disease, maternal-and-child mortality, and accidents. The healthcare system was sized and trained for that composition: primary care, immunisation, antenatal, basic surgery.

By 2024, the NCD share had more than doubled to 73 percent of all deaths. The system that performs first-class infectious-disease and maternal-and-child care is now mostly managing chronic illness that requires entirely different infrastructure: cardiology, endocrinology, oncology, dialysis, palliative care.

The system has the headcount — 411 doctors, 1,572 nurses, 6,891 total workforce per the 2025 MoH Annual Health Bulletin. The specialty mix is what’s short. Bhutan has near-zero domestic cardiologists, oncologists, endocrinologists, geriatricians; 1,301 patients per year are referred abroad at a state cost of approximately Nu 501 million annually because the country has no domestic capacity for their treatment.

Same population, same hospitals, same workforce. The diseases changed. The skill mix has not — yet.