Connecting a Nation: Bringing care to remote villages in Bhutan through WTI's Hub and Spoke Model

In many parts of the world, access to healthcare depends heavily on geography. If you’re lucky to live near a larger city, you may be able to see a medical specialist, but this leaves rural communities without access. Many families don’t have transportation and cannot get to the healthcare they need that is hours or even days away.

World Telehealth Initiative (WTI)’s program expansion strategy is designed with this reality in mind. Our growth focuses on strengthening local health systems by upskilling providers across the country and maximizing existing resources through a hub-and-spoke model.

How the hub and spoke model expands access

WTI uses a hub and spoke model to strengthen care across regions by connecting larger referral hospitals with smaller, remote clinics through telehealth. In this model, national and regional hospitals serve as hubs, providing specialist support to surrounding facilities with fewer resources or less specialized staff. Remote clinics can consult with specialists at the hub in real time for urgent or complex cases. Both hubs and spokes also receive support from WTI’s global corps of volunteer specialists.

Clinicians build their skills and knowledge over time through ongoing training and mentorship. Over time, reliance on the central hub decreases. This reduces unnecessary referrals and travel, eases pressure on national hospitals, and allows patients to receive care closer to home.

Bhutan: Building a national telehealth network

In the Kingdom of Bhutan, a small country in the Himalayas, WTI is building an national telehealth network to strengthen the country’s health system and reach extremely remote communities that have little to no healthcare access.

At the center of Bhutan’s network is Jigme Dorji Wangchuck National Referral Hospital, the country’s primary referral hospital. The majority of medical specialists are at Jigme Dorji Hospital, and patients from across the country travel to the hospital for the care they need. With Bhutan’s mountainous terrain, the trip is long and many patients cannot make it.

WTI’s program connects medical specialists at Jigme Dorji Hospital to other hospitals across the country, to maximize the country’s health resources and get patients the specialized care they need. Specialists at Jigme Dorji Hospital provides bedside patient care support, training and mentorship via telehealth to health facilities across Bhutan. Psychiatrists, critical care physicians, and more support clinicians across Bhutan, extending expertise well beyond the capital.

From there, the network expands outward.

Regional referral hospitals, including Central Regional Referral Hospital and Eastern Regional Referral Hospital, function as ‘spokes’. Specialists at Jigme Dorji Hospital support the regional referral hospitals with cases that need expertise only available in the capital. With ongoing support, clinicians at regional hospitals gain new skills and knowledge, needing less support from the capital over time. This layered structure improves coordination across levels of care and distributes clinical knowledge more evenly.

The program has been designed by leadership at Jigme Dorji Hospital to best meet the country’s health needs and maximize their existing resources. Two of the greatest areas of need are ICU care and Psychiatry. There are only 5 psychiatrists and 5 intensivists in Bhutan, all located at Jigme Dorji Hospital in the capital.  

Reaching remote communities with psychiatric care

The outer layer of the hub and spoke model includes extremely rural communities such as Lunana and Laya. Lunana is so remote that it can only be reached on foot. A community health worker comes to visit the village once a month and see patients, otherwise the community has no access to healthcare. There is a community health worker and general practitioner stationed in Laya, but health services are limited and any sort of specialized care is out of reach.

WTI has donated two telehealth devices to Laya and Lunana, which will be used for regular psychiatry clinics. A psychiatrist at Jigme Dorji will connect into the device to see patients who need psychiatric care. Additionally, medical specialists from Jigme Dorji and WTI’s international network will support the community health worker with patient care support in a variety of specialties.

Strengthening ICU care across the country

Bhutan has a limited number of intensivists nationwide, and a national directive requires specialist oversight for all ICU patients. Each hospital has an ICU but no intensivist, and has been asynchronously consulting with intensivists in the capital, which is slow and not ideal for patients in critical condition. By linking hospitals with ICU capacity to the intensivists in the capital through a coordinated telehealth network, the hub-and-spoke structure allows clinicians to access real-time specialist input and shared case discussions.

The program will support ICU care at Eastern Regional Referral Hospital, Central Regional Referral Hospital, Bajo Hospital, and Dewathang Military Hospital. This will greatly improve the support that intensivists can give to patients at the regional hospitals, enabling them to examine the patient via telehealth and discuss the care plan with local providers.

Long term system impact

Training is central to the model’s long-term success. As clinicians participate in consultations and ongoing case discussions, they build practical skills and confidence. Over time, experienced providers begin supporting additional sites, creating a train-the-trainer effect that expands capacity within the national workforce. The network becomes stronger as local leadership grows.

WTI’s program in Bhutan illustrates how thoughtful expansion can strengthen a country’s healthcare system. By aligning telehealth with national health policy and embedding it into routine care pathways, the hub-and-spoke model expands specialty access, supports local clinicians, and builds sustainable capacity across the country.

As WTI continues to grow, this model remains central to our work: connecting hubs to spokes, strengthening systems, and expanding access to specialty care nationwide.