RESUMO
The predominantly public financed and managed health system in Bhutan has evolved and grown remarkably in the past five and a half decades. Health services are available through a three-tier structure, i.e. primary, secondary and tertiary levels. Traditional and allopathic medicine services are integrated and delivered under one roof. Village health workers play an important role as a bridge between health services and the community to promote health. Programmes are in place to address the public health challenges facing the country. Health services are free as enshrined in the Constitution of Bhutan. Therefore, government revenue is the predominant source of health financing. In 2014, the total health expenditure (THE) was 3.6% of the gross domestic product (GDP). Despite the difficult geographical terrain and dispersed population settlements, access to health services has improved remarkably. Bhutan is among the top global performers in gains in life expectancy in the past 40 years. The targets of MDGs 4 and 5 have been achieved and since 2010, immunization levels have been maintained over 95%. However, the country faces multiple burden of health challenges. While communicable diseases remain a substantial burden, noncommunicable diseases (NCDs) are increasing. A few other emerging, challenging issues are crime, substance dependence and suicide/other mental health problems. Health equity requires attention as disparities exist in access to and utilization of health services as well as in health outcomes between urban and rural areas, income levels, districts and between western, central and eastern regions. Variations in efficiency levels among different districts and health facilities highlight the potential for improvement in overall efficiency. Though there is good evidence of intersectoral action, it needs to be fostered further to close the existing equity gaps and achieve the Sustainable Development Goals (SDGs).