In Just One Decade: Bhutan's path from no palliative care to a national policy

By Tara Devi Laabar
IAHPC member and Palliative Care Researcher,
Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;

Kinley Bhuti
Palliative Care Physician,
Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan; and

Yangden Yangden
Head of the Home Palliative Care Unit,
Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan

Bhutan had no palliative care activity until 2016 when two nurse-lecturers from its medical university travelled to Kerala, India, to attend six weeks of hands-on training at Pallium India.¹ On their return, they advocated for palliative care among relevant stakeholders, which resulted in a few additional nurses being sent to Kerala for training. The following year, a Cancer Control and Palliative Care Workshop held in the capital, Thimphu, sensitized Bhutanese healthcare professionals on the principles of palliative care.² In 2018, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) established the country's first palliative care service: home care for patients with advanced cancer living in Thimphu.³

Education & training were key

Education and training were crucial factors in developing palliative care. In 2018, a team from the Asia Pacific Hospice Palliative Care Network (APHN) began an annual training program on palliative care modules for Bhutanese healthcare professionals. When it was disrupted by COVID-19, the home care team continued to enhance their knowledge and skills through virtual collaborations and self-directed learning.

Locally designed care is important

While attending to the increasing demand for home palliative care, the handful of team members along with other JDWNRH professionals developed a local training module in collaboration with the Institute of Palliative Medicine (IPM) in Calicut, Kerala.

By 2020, PhD research had reported complex palliative care needs in Bhutan and emphasized an urgent need for culturally and spiritually appropriate services.^4-7  Other studies highlighted achievements and challenges faced by the home care service.^8,9

Huge response by healthcare providers

In 2023, the two online certificate courses, for pediatric and adult palliative care, (six 75-minute sessions) each drew more than 200 healthcare professionals from across the country. These programs were supported by Two Worlds Cancer Collaboration, Hyderabad Centre for Palliative Care, Australasian Palliative Link International, and Pallium India. The finding of the pre/post-tests of the pediatric session is encouraging.¹⁰

The impact of a trained physician

In early 2024, the nation's first palliative care physician, trained at the National Cancer Centre in Singapore, joined the home care team. Simultaneously, palliative care services expanded to in-patient consultations and an outpatient clinic at the national referral hospital. On average, 18 patient consults occur every month. The presence of a palliative care physician has contributed significantly to the expansion and formalization of services, enhancing both accessibility and integration of palliative care within the hospital system.  

Today's home care team

Today, the home care team comprises five dedicated nurses and a palliative care physician supported by a nurse anesthesiologist, physiotherapist, and geriatrician. Unique to Bhutan is the integration of traditional medicine with the national health system. Drungtsho, a traditional physician, is a member of the palliative care team.  

Traditional healing therapies include mindfulness and meditation practices, yoga and breathing exercises, steam and other herbal treatments.¹¹ Some of the monks from the Central Monastic Body are trained in palliative care and they are involved in spiritual care, particularly at end of life and during the bereavement period. 

As of July 2025, the home care team has cared for more than 950 patients, both cancer and noncancer, and their families. The service has recorded 794 deaths, of which 462 were at home.¹² 

Widening knowledge

The APHN training workshop resumed in May 2024, and within a year two rounds of in-person training were completed.^13,14 Other international organizations—including US-based Health Volunteer Overseas, IPM Calicut, and St. Christopher's Hospice in the UK—continue to support educational activities. These trainings have strengthened knowledge and skills among doctors, nurses, and other healthcare professionals throughout the country.

Advocacy impact on national policies

Besides emphasizing healthcare professionals’ training, palliative care advocacy with policymakers at the Ministry of Health and other relevant stakeholders has resulted in the inclusion of "palliative care" in its national health policy, development of a national palliative care guideline, and making palliative care training an annual program.

Accessibility & integration needs

Since the establishment of home palliative care, the availability and use of essential palliative care medicines—particularly morphine—has increased, especially at referral hospitals. However, much needs to be done to ensure adequate accessibility throughout the country. Today, multi-sector collaboration within Bhutan and international partnerships are involved in ongoing efforts to fully integrate palliative care into the national health system, in order to make it available at all levels of healthcare.

References

1. Maya C (2016), Bhutan tutors take home the message of palliative care. https://www.thehindu.com/news/cities/Thiruvananthapuram/Bhutan-tutors-take-home-the-message-of-palliative-care/article14431772.ece
2. Chagpar, AB. (2018). An Inspiring Experience at Cancer Control in Primary Care Course in Bhutan. https://connection.asco.org/do/inspiring-experience-cancer-control-primary-care-course-bhutan
3. Bay J, Yangden Y, Sherpa NL, and Luitel A (2019). Palliative Care: The Emerging Field in Bhutan, https://www.ons.org/publications-research/cjon/23/1/palliative-care-emerging-field-bhutan
4. Laabar TD, Saunders C, Auret K, Johnson CE (2021) ‘Palliative care needs among patients with advanced illnesses in Bhutan’ published in the BMC Palliative care Journal volume 20, number 8, 9 January 2021 https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-020-00697-9
5. Laabar TD, Auret K, Ngo H, Johnson CE (2021) ‘Support Needs for Family Members Caring for Patients with Advanced Illness in Bhutan’, published in the Journal of Palliative Care https://pubmed.ncbi.nlm.nih.gov/34898330/
6. Laabar TD, Saunders C, Auret K, Johnson CE (2022) Healthcare professionals’ views on how palliative care should be delivered in Bhutan: A qualitative study, published in PLOS Global Public Health, https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000775 
7. Laabar TD, Saunders C, Auret K, Johnson CE (2024) ‘There is no such word as palliative care for us at the moment’: A mixed-method study exploring the perceptions of healthcare professionals on the need for palliative care in Bhutan, https://journals.sagepub.com/doi/full/10.1177/26323524241272102
8. Bhuti K, Luitel A, Lhamo N, Denkar, Yangden, Dendup T (2023) Audit at the Jigme Dorji Wangchuck National Referral Hospital’s Palliative Care Unit, Covering the period from August 01, 2022 to August 01, 2023 
9. Dorji N, Yangden Y, Bhuti K,  Dorjey Y,  Tshering S, Giam CL, Laabar TD (2024). Palliative Care Services in Bhutan: Current Progress and Future Needs. 31(1);79-85, doi:10.25259/IJPC_206_2024. https://jpalliativecare.com/palliative-care-services-in-bhutan-current-progress-and-future-needs/
10. Laabar TD, Rayala S, Lynch-Godrei A, Bhandari P, Doherty M (2025). The impact of a children’s palliative care education and mentoring program (Project ECHO) on healthcare providers’ knowledge, confidence, and attitudes in Bhutan. Palliative and Supportive Care 23, e89, 1–8. https://doi.org/10.1017/S1478951525000033.
11. Ministry of Health. Launch of Palliative Care By Her Royal Highness Ashi Kesang Wangmo Wangchuck: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan; 2020. Available from: http://www.moh.gov.bt/launch-of-palliative-care-by-her-royal-highness-ashi-kesang-wangmo-wangchuck/
12. Email communication with Yangden, In-charge of home Palliative Care (5 July 2025)
13. Laabar TD (2024), Palliative Care Training of Trainers Workshop for Healthcare Professionals in Bhutan. https://aphn.org/palliative-care-training-of-trainers-workshop-for-healthcare-professionals-in-bhutan/
14. Kashiwagi H (2024) Learning and Perspectives on Palliative Care in Bhutan. https://aphn.org/learning-and-perspectives-on-palliative-care-in-bhutan/
15. ICPCN (2025). Celebrating the 2024 Children’s Palliative Care Leadership Graduates. https://icpcn.org/news/celebrating-the-2024-childrens-palliative-care-leadership-graduates/.
16. Doherty M, Palat M (2024) Apply for the 2025 Paediatric Palliative Medicine Fellowship for South and Southeast Asia. https://ehospice.com/inter_childrens_posts/apply-for-the-2025-paediatric-palliative-medicine-fellowship-for-south-and-southeast-asia/

---

Read more of this week's issue of Pallinews