Life expectancy in Bhutan has increased in the past 30 years, causing a rise in non-communicable diseases, including cancer.1 This has led to an upswing in the demand for palliative care. In 2018, the first palliative care pilot programme was launched in Bhutan; previously, Bhutan had no palliative care provision due to a lack of infrastructure and trained staff.2  In the pilot programme, nurses provided home-based palliative care, including pain management, symptom management, and patient and family engagement.2 Since its inception, 40 healthcare professionals have been trained in palliative care provision and the programme has expanded to include traditional medicine, and Bhuddist teachings and meditation.3 4


Bhutan has one of the fastest growing economies in the world, and a rapidly expanding population of under a million.1 5 This flourishing development also comes with an increase in life expectancy, rising from 53 years in 1990 to 70 years in 2016.1 However, this rapid improvement in life expectancy comes with an increased prevalence of non-communicable diseases, including cancer. Consequently, there is a greater need for palliative care.

For people with cancer, palliative care aims to improve quality of life for those with the disease, and their families and loved ones, as well as providing relief from the symptoms of the disease.6 34% of the people who require palliative care have cancer. As the cancer rate in Bhutan is growing, with an 82% incidence increase predicted by 2040

Before 2018, Bhutan had no palliative care provision.9 This was partly due to a lack of hospice and palliative care infrastructure, as well as palliative care not being included in medical training curriculum across the country.2 Bhutan is a mountainous country where much of the population has to travel to the capital city, Thimphu, or to India to receive care.2


In 2018, the Bhutan Cancer Society funded and launched Bhutan’s first palliative care programme.2 This initially consisted of three beds for palliative care in the oncology unit at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu, and four nurses recruited to provide home-based palliative care.4 Various non-governmental organisations sent oncologists, palliative care specialists and nurses on month-long assignments to assist Bhutanese medical staff in setting up the service. Healthcare staff also underwent a 10-day palliative care foundation course in Kerala, India .2

The goals of the programme were to provide access to palliative care services to people in their homes, add value and dignity at the end of life, enhance the cost-effectiveness of care by reducing hospitalisations and use of healthcare resources, and reduce overcrowding and bed shortages at the hospital.2

The nurses who carried out home care visits were accompanied by a medical oncologist or a pain specialist on their visits. The services provided at home included: patient and family assessment; symptom management; administering enemas; and care for tracheotomies, pressure sores, colostomies and lymphedema.2 Bi-weekly transport and home-care supplies, such as wound dressings, were also provided.2 Bhutan has long used traditional medicine in its care provision. These practices were also integrated into the palliative care, offering people the opportunity to receive care that respects and reflects their cultural background.3

What has been achieved?

An initial feedback assessment was undertaken by people with cancer who received care, carers and healthcare staff after the initial pilot. The responses collected were encouraging and home-based palliative care continued, with the Ministry of Health launching a palliative care package that integrated traditional medicine too.10 Palliative care provision was expanded beyond Jigme Dorji Wangchuck National Referral Hospital and Thimphu.3

The Ministry of Health’s new plan means that care is now personalised to each person, with Buddhist teachings and meditation being provided as part of care. Drungtshos and menpas (Bhutanese traditional medicine practitioners) are now part of the multidisciplinary team that provides palliative care.3 11 Other traditional therapies such as massage, trigger release, cupping, moxa, hot and cold compression, and acupuncture are also provided.12

In 2019, 16 healthcare professionals had undergone palliative care training; this number has risen to 40 in 2023 as palliative care continues to be provided in Bhutan.

Next steps

A full evaluation of the benefits and impact of the service is being planned.4

Online training courses for Bhutanese healthcare professionals are ongoing as more staff are trained in the provision of palliative care. Palliative care is also now included in the nursing and community health curriculum at the Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan.4

Following on from the success of the traditional medicine-integrated palliative care, similar services are planned to be rolled out across the country to all district-level hospitals.3


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