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It is a design mapping and does not imply that every patient follows the sequence.", "tags": [], "territory": "Bhutan, formal service-delivery and referral hierarchy", "title": "Formal primary-to-national referral hierarchy", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_national_policy_and_2018_ehealth_strategy_with_2017_review_context", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:BTN:relationships-networks:formal-service-information-network", "source_projection_ids": [ "country-improvement-source:BTN:national-health-policy-2011", "country-improvement-source:BTN:who-hit-review-2017", "country-improvement-source:BTN:national-ehealth-strategy-2018" ], "support_state": "candidate_supported", "target_slot": "tiered-service-and-information-design", "target_view": "delivery", "typed_fields": { "boundary": "the policy and strategy do not establish achieved interoperability or complete facility adoption", "information_network": "centralized HMIS and digitized health records are policy objectives; the 2018 strategy recorded siloed systems and set interoperability targets", "primary_level": "outreach clinics and basic health units", "secondary_level": "district hospitals", "tertiary_level": "regional referral hospitals and national referral hospitals" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, National Health Policy, sections 5.1 to 5.7 and 7.1 to 7.2; Thinley et al., 2017; Ministry of Health, National eHealth Strategy and Action Plan, 2018.", "country_ids": [ "BTN" ], "coverage_domains": [ "authoritative_review", "facility_data", "governance", "hospital_organization", "networks", "primary_care", "referral_design" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "National Health Policy, physical PDF pages 9 to 12; WHO review, health-information and service-delivery chapters; National eHealth Strategy, physical PDF pages 10 and 14 to 18." }, "material_id": "material:b5c873338fa2a78bf46d9a52", "notes": [ "Do not present the information-system objective as a completed interoperability assessment." ], "origin": "candidate-analytical-mappings", "period": "Policy issued 2011; WHO review through 2017; eHealth strategy 2018 to 2023", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b", "page_count": 28, "response_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b" }, "statement": "The national policy maps a primary, district, regional and national hierarchy and calls for centralized HMIS and digitized records. The 2018 eHealth strategy records siloed systems and proposes interoperability targets. These are formal design and baseline provisions, not evidence of connected records or observed continuity across every facility.", "tags": [], "territory": "Bhutan, national formal service hierarchy", "title": "Formal tiered service and information design", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf" }, { "kind": "source_reference", "source": "The Kingdom of Bhutan Health System Review", "url": "https://iris.who.int/handle/10665/255701" }, { "kind": "source_reference", "source": "National eHealth Strategy and Action Plan 2018-2023", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National_eHealth_Strategy.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_national_policy_and_reported_in_the_2017_who_system_review", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:BTN:decision-autonomy:jdwnrh-autonomy-boundary", "source_projection_ids": [ "country-improvement-source:BTN:national-health-policy-2011", "country-improvement-source:BTN:who-hit-review-2017" ], "support_state": "candidate_supported", "target_slot": "national-referral-hospital-autonomy", "target_view": "autonomy", "typed_fields": { "autonomy_status": "described as autonomous", "functional_obligation": "technical backup to regional referral and district hospitals", "provider": "Jigme Dorji Wangchuck National Referral Hospital", "time_boundary": "WHO review reports autonomy began in 2014; current arrangements require confirmation" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, National Health Policy, section 5.7; Thinley et al., 2017.", "country_ids": [ "BTN" ], "coverage_domains": [ "authoritative_review", "autonomy", "decision_rights", "governance", "hospital_organization", "networks" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "National Health Policy, physical PDF page 10, section 5.7; WHO review, physical PDF page 61." }, "material_id": "material:77c041d00b9353482f665e9a", "notes": [ "Confirm current legal and board arrangements before describing the autonomy as current." ], "origin": "candidate-analytical-mappings", "period": "Policy issued 2011; WHO review reports JDWNRH autonomy from 2014 through its 2017 review period", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b", "page_count": 28, "response_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b" }, "statement": "The policy and WHO review support a bounded autonomy mapping for JDWNRH: the hospital is described as autonomous while retaining national referral and technical-backup obligations. They do not establish identical autonomy for regional, district or traditional medicine hospitals.", "tags": [], "territory": "Bhutan, national referral hospital and its technical-backup relationships", "title": "JDWNRH autonomy and system obligation", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://iris.who.int/handle/10665/255701" }, { "kind": "source_reference", "source": "National Health Policy", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_the_universitys_official_governance_description_cross_checked_against_the_2017_who_review", "mapping_group": "actors_and_functions", "mapping_id": "candidate-mapping:BTN:actors-functions:medical-education-and-training-role", "source_projection_ids": [ "country-improvement-source:BTN:kgumsb-university-page", "country-improvement-source:BTN:who-hit-review-2017" ], "support_state": "candidate_supported", "target_slot": "medical-education-and-training-governance", "target_view": "decisions", "typed_fields": { "boundary": "the evidence supports education and research functions, not operational control of hospitals", "governance": "Governing Council provides policy direction and strategic oversight", "institution": "Khesar Gyalpo University of Medical Sciences of Bhutan", "role": "apex institution for medical and health-care education and training" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Khesar Gyalpo University of Medical Sciences of Bhutan, The University; Thinley et al., 2017.", "country_ids": [ "BTN" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "networks", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "KGUMSB, THE KGUMSB section, lines 94 to 99; WHO review, physical PDF page 130." }, "material_id": "material:f0679b8c6d768ff7707e11e9", "notes": [ "Do not infer university authority over health-facility operations." ], "origin": "candidate-analytical-mappings", "period": "University established 2013 under the 2012 Act; official page retrieved 2026-08-15", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "0b223d4d4a113749072c988c4163e49530779631c2df86da79aaee93bdf630a6" }, "statement": "KGUMSB is mapped as the apex education and training institution governed by a council. This is not mapped as hospital autonomy, because the official description does not provide evidence of that operational relationship.", "tags": [], "territory": "Bhutan, national medical education and training", "title": "Medical education and training governance", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.kgumsb.edu.bt/?page_id=19892" }, { "kind": "source_reference", "source": "The Kingdom of Bhutan Health System Review", "url": "https://iris.who.int/handle/10665/255701" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_national_policy_cross_checked_against_the_2017_who_system_review", "mapping_group": "actors_and_functions", "mapping_id": "candidate-mapping:BTN:actors-functions:steward-district-provider-architecture", "source_projection_ids": [ "country-improvement-source:BTN:national-health-policy-2011", "country-improvement-source:BTN:who-hit-review-2017" ], "support_state": "candidate_supported", "target_slot": "national-district-provider-roles", "target_view": "functions", "typed_fields": { "district_actor": "Dzongkhag administration and district health administration", "district_role": "district planning, monitoring and supervision within local government", "national_actor": "Ministry of Health", "national_role": "policy, national planning, service design and gatekeeping policy", "provider_boundary": "service-delivery roles span primary, district, regional and national facilities" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, National Health Policy, 2011; Thinley et al., The Kingdom of Bhutan Health System Review, 2017.", "country_ids": [ "BTN" ], "coverage_domains": [ "actors", "authoritative_review", "decision_rights", "governance", "government_responsibilities" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "National Health Policy, sections 5 and 10; WHO review, physical PDF page 64." }, "material_id": "material:7eef3e61015f12e96b4e7f85", "notes": [ "Check current decentralization instruments before representing district authority as unchanged." ], "origin": "candidate-analytical-mappings", "period": "Policy issued 2011; district arrangement reported for the 2017 review period", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b", "page_count": 28, "response_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b" }, "statement": "Bhutan's candidate organizational map separates Ministry stewardship from dzongkhag-linked district health administration and facility delivery. The available review describes the district arrangement in 2017, while the policy establishes national functions rather than a current delegation schedule.", "tags": [], "territory": "Bhutan, including dzongkhag-level administration", "title": "National, dzongkhag and facility roles", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf" }, { "kind": "source_reference", "source": "The Kingdom of Bhutan Health System Review", "url": "https://iris.who.int/handle/10665/255701" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_national_policy_triangulated_with_the_2017_who_review_2025_narrative_synthesis_and_2020_to_2023_national_health_accounts", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:BTN:decision-autonomy:public-private-regulatory-boundary", "source_projection_ids": [ "country-improvement-source:BTN:national-health-policy-2011", "country-improvement-source:BTN:who-hit-review-2017", "country-improvement-source:BTN:quality-narrative-synthesis-2025", "country-improvement-source:BTN:national-health-accounts-2025" ], "support_state": "candidate_supported", "target_slot": "regulated-private-participation", "target_view": "public-private", "typed_fields": { "boundary": "policy permission and financial classifications do not measure current market size, contracts or provider-market shares", "private_participation": "regulated private and foreign investment may provide high-end specialized diagnostics and treatment", "public_sector": "public health services remain public under the national policy", "reported_financing": "2020 to 2023 accounts report direct household payments for specified private pharmacies, diagnostic centres and supplementary services", "reported_market": "2017 review reported few private diagnostic centres and pharmacy shops" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, National Health Policy, sections 10.1 and 15; Thinley et al., 2017; Quality as Part of Universal Health Coverage in Bhutan, 2025; Ministry of Health, National Health Accounts 2025.", "country_ids": [ "BTN" ], "coverage_domains": [ "authoritative_review", "decision_rights", "governance", "market_structure", "ownership", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "National Health Policy, physical PDF pages 16 and 21; WHO review, physical PDF pages 65 and 106; National Health Accounts, physical PDF page 20." }, "material_id": "material:fad0ff99e3edec55befff72d", "notes": [ "Do not turn the policy permission into a claim that private providers are widely available or contracted." ], "origin": "candidate-analytical-mappings", "period": "Policy issued 2011; private-market characterization reported in 2017, synthesized in 2025 and financially classified for 2020/21 to 2022/23", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b", "page_count": 28, "response_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b" }, "statement": "Bhutan's policy permits regulated private participation in specified specialized diagnostic and treatment services while prohibiting privatization of public health services. The review and 2020 to 2023 accounts report limited private diagnostic, pharmacy and specified supplementary payment contexts, not a current provider census, market share or contracting map.", "tags": [], "territory": "Bhutan, national health-service market", "title": "Public services and regulated private participation", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf" }, { "kind": "source_reference", "source": "The Kingdom of Bhutan Health System Review", "url": "https://iris.who.int/handle/10665/255701" }, { "kind": "source_reference", "source": "Quality as Part of Universal Health Coverage in Bhutan: A Narrative Synthesis", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13084747/" }, { "kind": "source_reference", "source": "National Health Accounts for Financial Years 2020/21, 2021/22 and 2022/23", "url": "https://moh.gov.bt/wp-content/uploads/2026/05/B5_NHA-Report-2.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "reported_from_the_2017_who_review_2022_policy_dialogue_and_2023_bulletin_with_observed_traditional_medicine_and_two_hospital_satisfaction_evidence", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:BTN:delivery-referrals:observed-bypass-and-traditional-constraints", "source_projection_ids": [ "country-improvement-source:BTN:who-hit-review-2017", "country-improvement-source:BTN:traditional-medicine-primary-2024", "country-improvement-source:BTN:quality-narrative-synthesis-2025", "country-improvement-source:BTN:annual-health-bulletin-2023", "country-improvement-source:BTN:health-inequities-policy-dialogue-2022", "country-improvement-source:BTN:regional-referral-hospital-satisfaction-2025" ], "support_state": "candidate_supported", "target_slot": "reported-referral-implementation-boundary", "target_view": "delivery", "typed_fields": { "allopathic_pathway": "WHO review reported a functioning referral system with no mechanism to discourage self-referrals; a 2022 policy-dialogue summary also describes reported referral bypass", "data_boundary": "the 2023 bulletin documents routine facility reporting and its omission of deaths outside facilities; it is not a live registry or complete population dataset", "observed_hospital_experience": "a 2025 retrospective study at two regional referral hospitals found accessibility and convenience had the lowest satisfaction score", "traditional_pathway": "2024 article reports unclear centre-to-centre referral processes", "utilization_boundary": "sources identify implementation constraints but do not provide a linked national patient-flow dataset or national bypass rate" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Thinley et al., The Kingdom of Bhutan Health System Review, 2017; Dorji et al., 2022; Ministry of Health, Annual Health Bulletin 2023; Tshokey et al., 2024; Quality as Part of Universal Health Coverage in Bhutan, 2025; Dorji et al., 2025.", "country_ids": [ "BTN" ], "coverage_domains": [ "authoritative_review", "facility_data", "hospital_organization", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": null, "institution": null, "locator": { "description": "WHO review, physical PDF page 33; Dorji et al. 2022, referral-pathways section; Annual Health Bulletin, physical PDF page 17; Tshokey et al., web lines 49 to 52; 2025 narrative synthesis, Quality foundations; Dorji et al. 2025, Results and Discussion." }, "material_id": "material:47097e08374f23a0fa20eb6d", "notes": [ "Do not calculate a national bypass proportion from these qualitative or review-level statements." ], "origin": "candidate-analytical-mappings", "period": "WHO review through 2017; policy dialogue 2020 and article 2022; bulletin reporting through 2022; traditional-medicine article 2024; two-hospital study and narrative synthesis 2025", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "7f13b807444022184630ecb51b4bec16d2cea192e2b88c3a226e3113e8f0172f", "page_count": 264, "response_sha256": "7f13b807444022184630ecb51b4bec16d2cea192e2b88c3a226e3113e8f0172f" }, "statement": "The WHO review and a 2022 policy-dialogue summary report self-referral or referral bypass in their stated contexts, while the traditional medicine article reports unclear referral processes in that service stream. The 2023 bulletin documents facility-reporting limits, and a 2025 two-hospital study records lower satisfaction with accessibility and convenience. 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The 2024 article reports cross-referral in co-located services but also unclear referral processes among traditional medicine centres, so this mapping keeps integration separate from reliable observed referral completion.", "tags": [], "territory": "Bhutan, traditional medicine units and allopathic services", "title": "Traditional and allopathic cross-referral", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.bsj.com.bt/index.php/bsj/article/download/113/68?inline=1" }, { "kind": "source_reference", "source": "National Health Policy", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf" }, { "kind": "source_reference", "source": "The Kingdom of Bhutan Health System Review", "url": "https://iris.who.int/handle/10665/255701" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, Royal Government of Bhutan. Annual Health Bulletin 2023. https://moh.gov.bt/wp-content/uploads/2025/01/Annual-Health-Bulleti-2023.pdf", "country_ids": [ "BTN" ], "coverage_domains": [ "facility_data", "hospital_organization", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "many of the deaths occurs outside health facilities", "institution": "HMIS and Research Section, Policy and Planning Division, Ministry of Health, Royal Government of Bhutan", "locator": { "locator_type": "pdf_page_anchor", "source_word_anchor": "many of the deaths occurs outside health facilities", "source_word_count": 9 }, "material_id": "material:e2b15cb12e23f86951c28a85", "notes": [ "Retain the bulletin's reporting year and facility-data boundary.", "Do not convert facility-reported deaths into a national mortality estimate." ], "origin": "country-evidence-improvement-sources", "period": "Bulletin published 2023 with health-indicator reporting through 2022", "publication_date": null, "publication_year": 2023, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "9e200f1d00206f462110b2502f3834313bb7dc2089ab124461d12e68f9e2086f", "page_count": 182, "response_sha256": "9e200f1d00206f462110b2502f3834313bb7dc2089ab124461d12e68f9e2086f" }, "statement": "The bulletin reports national health indicators from routine programme and facility sources and notes that facility-recorded deaths omit many deaths outside facilities. It supplies reported administrative context, not a complete population mortality or patient-flow dataset.", "tags": [], "territory": "Bhutan, reporting health facilities", "title": "Annual Health Bulletin 2023", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/Annual-Health-Bulleti-2023.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Tshokey, Kelzang, Gyeltshen T, Tamang M. Challenges in Delivery of Bhutanese Traditional Medicine (Sowa Rigpa) Services at Primary Healthcare Centres in Bhutan. 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It gives observed and reported operational constraints for this service stream, not a national measure of all referral completion.", "tags": [], "territory": "Bhutan, traditional medicine units with emphasis on primary health-care centres", "title": "Challenges in Delivery of Bhutanese Traditional Medicine (Sowa Rigpa) Services at Primary Healthcare Centres in Bhutan", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.bsj.com.bt/index.php/bsj/article/download/113/68?inline=1" }, { "kind": "embedded_source_url", "source": "URL supplied in citation", "url": "https://doi.org/10.47811/bsj.0011050814" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Dorji T, et al. Health inequities in Bhutan's free healthcare system: a health policy dialogue summary. 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It is an interpretive, source-bounded account rather than a national patient-level bypass estimate.", "tags": [], "territory": "Bhutan, national health-system discussion with district and referral-hospital examples", "title": "Health inequities in Bhutan's free healthcare system: a health policy dialogue summary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12039577/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, Royal Government of Bhutan. National Health Accounts for Financial Years 2020/21, 2021/22 and 2022/23. 2025. https://moh.gov.bt/wp-content/uploads/2026/05/B5_NHA-Report-2.pdf", "country_ids": [ "BTN" ], "coverage_domains": [ "facility_data", "governance", "government_responsibilities", "hospital_organization", "market_structure", "ownership", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "government funding covers most of Bhutan’s health spending", "institution": "Ministry of Health, Royal Government of Bhutan", "locator": { "locator_type": "pdf_page_anchor", "source_word_anchor": "government funding covers most of Bhutan’s health spending", "source_word_count": 8 }, "material_id": "material:32c749846577527db550a53b", "notes": [ "Keep expenditure classifications distinct from ownership, contracting or utilization measures.", "Do not use dzongkhag expenditure concentration as proof of inequitable access or referral volume." ], "origin": "country-evidence-improvement-sources", "period": "Financial years 2020/21, 2021/22 and 2022/23; report published 2025", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "5ff05d41d5524933859995b0bb81316741e1f4c6c127779402b04b1adc489d0e", "page_count": 55, "response_sha256": "5ff05d41d5524933859995b0bb81316741e1f4c6c127779402b04b1adc489d0e" }, "statement": "The accounts report tax-funded public services, Ministry and local-government financing channels, direct household payments for specified private and supplementary services, and expenditure concentrated in dzongkhags with referral hospitals. These are reported financial classifications and estimates, not provider-market shares or measures of clinical referral use.", "tags": [], "territory": "Bhutan, national health-financing system and dzongkhag expenditure estimates", "title": "National Health Accounts for Financial Years 2020/21, 2021/22 and 2022/23", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2026/05/B5_NHA-Report-2.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, Royal Government of Bhutan. National Health Policy. https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf", "country_ids": [ "BTN" ], "coverage_domains": [ "autonomy", "decision_rights", "facility_data", "governance", "government_responsibilities", "hospital_organization", "market_structure", "networks", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "structured into a three-tiered health system", "institution": "Ministry of Health, Royal Government of Bhutan", "locator": { "locator_type": "pdf_page_anchor", "source_word_anchor": "structured into a three-tiered health system", "source_word_count": 6 }, "material_id": "material:146177ac3ddd4b4a5b36f827", "notes": [ "Treat policy provisions as formal design, not evidence that every facility or patient follows them.", "The policy file does not establish the current operational autonomy of every provider." ], "origin": "country-evidence-improvement-sources", "period": "National policy issued 2011; website file retrieved 2026-08-15", "publication_date": null, "publication_year": 2011, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b", "page_count": 28, "response_sha256": "cbdca5c9450c1dd7774e9046489d58296a01992c2df1da522dee520a0258e25b" }, "statement": "The policy sets a three-tier service hierarchy, assigns referral and gatekeeping design to the Ministry, identifies JDWNRH as autonomous for technical backup, calls for centralized HMIS, integrates traditional medicine, and permits regulated private participation without privatizing public health services.", "tags": [], "territory": "Bhutan, national health system", "title": "National Health Policy", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National-Health-Policy.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, Royal Government of Bhutan. National eHealth Strategy and Action Plan 2018-2023. 2018. https://moh.gov.bt/wp-content/uploads/2025/01/National_eHealth_Strategy.pdf", "country_ids": [ "BTN" ], "coverage_domains": [ "decision_rights", "facility_data", "governance", "government_responsibilities", "networks", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "current ehealth systems are siloed and needs to be integrated", "institution": "Ministry of Health, Royal Government of Bhutan", "locator": { "locator_type": "pdf_page_anchor", "source_word_anchor": "current ehealth systems are siloed and needs to be integrated", "source_word_count": 10 }, "material_id": "material:4a06c1ed4f31760a2d95fdbf", "notes": [ "Treat the strategy's 2020 and 2023 milestones as intended targets, not completed implementation.", "Do not infer current interoperability or facility connectivity from the 2018 baseline and plan." ], "origin": "country-evidence-improvement-sources", "period": "Strategy and action plan for 2018 to 2023", "publication_date": null, "publication_year": 2018, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "8efb79327150b2ed3632e75c65c3c8157afa76fbe25ea9fdcb68025946214e1d", "page_count": 45, "response_sha256": "8efb79327150b2ed3632e75c65c3c8157afa76fbe25ea9fdcb68025946214e1d" }, "statement": "The strategy records siloed information systems at its 2018 baseline and sets governance, architecture, interoperability and facility-connection targets through 2023. It is a formal plan and baseline description, not evidence that its targets were achieved nationwide.", "tags": [], "territory": "Bhutan, national health-information and facility network", "title": "National eHealth Strategy and Action Plan 2018-2023", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://moh.gov.bt/wp-content/uploads/2025/01/National_eHealth_Strategy.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Dorji T, et al. Patient satisfaction in regional referral hospitals of Bhutan: Insights from a cross-sectional study. PLOS ONE. 2025;20:e0312629. https://pmc.ncbi.nlm.nih.gov/articles/PMC12129210/", "country_ids": [ "BTN" ], "coverage_domains": [ "facility_data", "hospital_organization", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "accessibility and convenience domain received the lowest score", "institution": "PLOS ONE", "locator": { "locator_type": "article_sections", "source_word_anchor": "accessibility and convenience domain received the lowest score", "source_word_count": 8 }, "material_id": "material:4324642da36e1cec1cf34822", "notes": [ "Do not generalize the two regional referral hospitals to all Bhutanese facilities.", "Retain the study's retrospective cross-sectional and response-bias limitations." ], "origin": "country-evidence-improvement-sources", "period": "Retrospective cross-sectional analysis published 2025", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "71d00ff277d5b393d1e4f109ba90e35fd6529fdb0a483901e2115779224dad8f" }, "statement": "The study analyses archived patient-satisfaction surveys from two state-owned regional referral hospitals and reports the lowest domain score for accessibility and convenience. It is an observed two-hospital result, not a national measure of satisfaction, access or referral completion.", "tags": [], "territory": "Bhutan, Mongar Eastern and Gelephu Central Regional Referral Hospitals", "title": "Patient satisfaction in regional referral hospitals of Bhutan: Insights from a cross-sectional study", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12129210/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Quality as Part of Universal Health Coverage in Bhutan: A Narrative Synthesis. 2025. 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Its synthesis is useful for triangulation but cannot replace the cited primary data or a contemporary nationwide referral audit.", "tags": [], "territory": "Bhutan, national health system with facility-level examples", "title": "Quality as Part of Universal Health Coverage in Bhutan: A Narrative Synthesis", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13084747/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization. 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The update documents a 2025 process, not an adopted strategy or achieved digital-health outcome.", "tags": [], "territory": "Bhutan, national digital-health strategy process", "title": "Strengthening Bhutan’s National Digital Health Strategy 2025", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.who.int/bhutan/news/detail/03-03-2025-world-health-day-2019-gasa-dzongkhag" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Thinley S, Tshering P, Wangmo K, et al. The Kingdom of Bhutan Health System Review. Health Systems in Transition. 2017;7(2). 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The University. https://www.kgumsb.edu.bt/?page_id=19892", "country_ids": [ "BTN" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "networks", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "first and only medical university in the country", "institution": "Khesar Gyalpo University of Medical Sciences of Bhutan", "locator": { "locator_type": "web_lines", "section": "THE KGUMSB", "source_word_anchor": "first and only medical university in the country", "source_word_count": 8 }, "material_id": "material:17123ba24a4508c8566b7abe", "notes": [ "Do not label the university autonomous: this page describes council governance, not an autonomy classification.", "Do not infer authority over service delivery from the education mandate." ], "origin": "country-evidence-improvement-sources", "period": "Official university page retrieved 2026-08-15; establishment cited as 2013 under the 2012 Act", "publication_date": null, "publication_year": 2026, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "0b223d4d4a113749072c988c4163e49530779631c2df86da79aaee93bdf630a6" }, "statement": "KGUMSB describes itself as the country's apex medical education and training institution, established under the University of Medical Sciences Act, and governed by a Governing Council. The page establishes governance and educational functions, but does not establish hospital operational autonomy.", "tags": [], "territory": "Bhutan, national medical and health-care education and training", "title": "The University", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.kgumsb.edu.bt/?page_id=19892" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank Documents and Reports. Bhutan - COVID-19 Emergency Response and Health Systems Preparedness Project. 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Primary Health Care in Bhutan - Findings from the Primary Health Care Performance Initiative Assessment. 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