ASIA NEWS NETWORK, Gelephu, Bhutan
GELEPHU – As the country’s health system grapples with a shortage of specialist doctors, an old idea is finding new relevance – telemedicine – through which medical expertise can reach remote health centres.
This solution may offer the closest thing to a fix for the government’s ambitious election pledge of “One Gewog, One Doctor” — a promise that has already hit a wall.
During the meet-the-press session in March, Health Minister Tandin Wangchuk acknowledged that deploying a doctor to every gewog was not feasible. Lyonpo said that instead the health ministry was planning to invest in 29 mobile medical units to bring healthcare services closer to remote communities.
Telemedicine offers an alternative. Here’s how it works.
Inside a consultation room at the Central Regional Referral Hospital (CRRH) in Gelephu, 64-year-old Lilly Maya Gurung sits before a high-definition camera. Some two hundreds kilometres away in Thimphu, the country’s only rheumatologist appears on the screen. For nearly half an hour, the specialist reviews her swollen joints, asks about her pain, adjusts her medicines and reassures her.
“You have rheumatoid arthritis,” the doctor tells her. “It is a chronic disease, but with regular medicines and follow-up, you can live well.”
Rheumatoid arthritis is an auto-immune disease in which the body’s immune system mistakenly attacks healthy joints, causing pain, swelling and stiffness. Left untreated, it can permanently damage joints and severely affect daily life.
When the consultation ends, Lilly Maya Gurung folds her hands in gratitude. She no longer has to undertake the exhausting journey to Thimphu, navigate long queues at the national referral hospital, or spend thousands of ngultrum travelling for routine follow-up appointments.
“I am relieved,” she says before leaving.
For another patient – a schoolgirl living with an autoimmune disease – the consultation means something equally valuable.
She arrives in her school uniform. Without teleconsultation, she would have missed classes each time she travelled to Thimphu for specialist reviews. Instead, after speaking with the specialist, she heads straight back to school.
For these patients, teleconsultation saves time, money, and unnecessary travel. For Bhutan, it present an opportunity. If the country cannot realistically station every specialist wherever patients need them, technology can allow specialist expertise to reach patients and the doctors caring for them instead.
An official from Ministry of Health (MoH) said that was precisely the role telemedicine is intended to play. “Digital consultations are not designed to replace face-to-face healthcare or doctors serving communities. Rather, teleconsultation is viewed as a complementary service that connects patients and frontline healthcare providers with scarce specialist expertise, particularly in remote areas.”
Although the healthcare workforce has grown steadily over the years, the limitation still continues. According to MoH’s Annual Health Bulletin 2025, the number of doctors increased from 336 in 2020 to 411 in 2024, raising doctor density from 4.62 to 5.29 per 10,000 population.
Currently, Bhutan has 177 specialists and sub-specialists, alongside 173 medical officers serving a healthcare network of 59 hospitals, 193 primary health centres, and 555 outreach clinics.
Yet specialist expertise is largely concentrated in Thimphu. And certain specialties have only one or two doctors serving the entire country. Rheumatology is one example.
For patients from Gelephu, Samdrupjongkhar or Trashigang, routine appointments often require days of travel, accommodation costs, and time away from work or school.
More than a video call
Telemedicine is often mistaken for video consultation. In reality, it is the delivery of healthcare using information and communication technology to overcome one of healthcare’s oldest challenges – distance.
It allows patients, frontline doctors, and specialists to connect without everyone being in the same place. Rather than replacing hospitals or healthcare workers, telemedicine extends the reach of existing healthcare services by allowing specialist knowledge to travel where specialists themselves cannot.
Teleconsultation is only one component of telemedicine. Modern telemedicine also includes remote patient monitoring, tele-ICU support, specialist case discussions, virtual multidisciplinary meetings and continuing medical education for healthcare workers.
Using advanced examination equipment connected through secure digital platforms, specialists can not only see and speak with patients but also review medical images and, where appropriate, remotely assess heart and lung sounds.
The teleconsultation service operating in Gelephu uses equipment donated by the World Telehealth Initiative (WTI), a US-based non-profit organisation.
Proof that it works
The rheumatology teleconsultation service began on May 21 this year in Gelephu. In just two months, the hospital recorded more than 40 teleconsultation visits involving around seven patients requiring repeated follow-up for chronic disease management.
CRRH Medical Superintendent Dr Choeda Gyaltshen said the benefits became immediately apparent.
“Patients avoid costly travel, they no longer spend hours waiting outside specialist clinics, and prescriptions for medicines unavailable locally can be processed through JDWNRH and collected without patients travelling themselves,” he said.“It is particularly useful for chronic diseases that require regular follow-up rather than physical procedures.”
The hospital has also established a Digital Health Innovation Unit, with plans to expand teleconsultation into additional specialties and strengthen collaboration with the Eastern Regional Referral Hospital in Mongar.
For Dr Jigme Yoezer, who leads the unit, telemedicine’s value extends beyond convenience.
“When we calculated the economic savings, we included travel, accommodation, food and return journeys to JDWNRH,” he said. “For many patients, those costs can reach Nu 30,000 to Nu 40,000 over two months. Teleconsultation removes much of that burden.”
The project began as a pilot to determine whether teleconsultation could work in Bhutan.
“The results demonstrated both proof of concept and proof of value,” he said. “Patients benefit, and the health system also reduces costs.”
Additional telemedicine equipment donated through WTI is expected to arrive soon, allowing services to expand to hard to reach places such as Laya and Lunana.
Building a national digital health system
Bhutan is not starting from scratch. The country first experimented with telemedicine through the Bhutan Health Telematics Project between 2000 and 2002. Those early efforts demonstrated the technology’s promise but were constrained by limited internet connectivity, equipment ,and digital infrastructure.
Today, those conditions have changed.
The MoH official said the current pilot was intended not simply to introduce teleconsultation, but to strengthen country’s own digital health capacity, with emphasis on transferring technical knowledge, training healthcare workers and ICT personnel, documenting operational experience and integrating telemedicine into Bhutan’s existing digital health systems.
“While external partners such as WTI have helped establish the current pilot, the long-term objective is a locally managed, sustainable and interoperable telemedicine ecosystem,” the official said.
The health ministry also envisions teleconsultation as only the first step. Over time, telemedicine is expected to evolve into a broader national digital health platform supporting specialist consultations, remote clinical decision-making, tele-ICU services, remote patient monitoring and other advanced digital health services as infrastructure, workforce capacity and governance systems mature.
These services require robust connectivity, appropriate medical devices, cybersecurity safeguards, clinical protocols and trained healthcare professionals, meaning expansion would occur gradually rather than all at once.
The ministry is also developing policy, governance, and financing mechanisms to ensure telemedicine becomes an integrated part of country’s healthcare system beyond the pilot phase.
The health ministry emphasises that telemedicine is not intended to replace doctors in communities, but to support them by connecting patients and frontline health workers with specialists when needed.
A global shift
Bhutan’s direction reflects a broader international trend accelerated by the Covid-19 pandemic. Countries including India, Australia, the United Kingdom and the United States have significantly expanded telemedicine to improve access to specialist care, particularly for rural and remote populations.
The World Health Organisation also identifies digital health as an important tool for advancing universal health coverage, especially in countries where specialist healthcare workers are limited.
For smaller countries with dispersed populations, telemedicine is increasingly becoming part of mainstream healthcare rather than an emergency alternative.