In a major milestone for Bhutan’s healthcare system, the country has officially marked the successful completion of a groundbreaking telemedicine initiative that is transforming how maternal and child health services are delivered—especially in the nation’s most remote and rugged regions. The conclusion of the “Project for Strengthening Maternal and Child Health by Telemedicine System Establishment” signals not just the end of a project, but the beginning of a new era where geography is no longer a barrier to safe motherhood.
Implemented in partnership between the Japan International Cooperation Agency (JICA) and Bhutan’s Ministry of Health (MoH), the project has introduced cutting-edge digital health technology into Bhutan’s public health system, dramatically improving access to quality perinatal care for women across the country.
Launched in March 2023, the project was designed to address one of Bhutan’s most persistent healthcare challenges: ensuring timely, high-quality maternal and child health services in a country defined by steep mountains, scattered settlements, and difficult terrain. For many pregnant women living in high-altitude or hard-to-reach communities, accessing specialized care has long meant hours—or even days—of travel. This project sought to change that reality.
Bringing Specialist Care to the Last Mile
At the heart of the initiative is the deployment of Integral Cardiotocography (iCTG) technology—a sophisticated fetal monitoring system that allows healthcare workers to track fetal heart rates and uterine contractions in real time. Crucially, the data can be transmitted digitally, enabling specialists at referral hospitals to support frontline health workers in distant clinics.
What once required physical referral to urban hospitals can now, in many cases, be assessed remotely—saving precious time, reducing risk, and easing the burden on expectant mothers and their families.
“This project is a game changer,” said Karma Tenzin, Senior Programme Officer from the Non-Communicable Disease Division under the Department of Public Health at the Ministry of Health. “After the conclusion of the project, the Ministry of Health, Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), and the National Medical Services will take this forward.”
Sustainability Built into the System
One of the most striking achievements of the project is its focus on long-term sustainability. Rather than operating as a standalone pilot, the initiative has been firmly embedded within Bhutan’s national health system.
Karma Tenzin emphasized that sustainability has been carefully planned from the outset. “During the project implementation, KGUMSB has already incorporated telemedicine and iCTG training into its curriculum,” he said. “This means that once students graduate, there will be no need for separate training. They will enter the health system already equipped with these skills.”
This integration into medical and nursing education ensures that the benefits of the project will extend well beyond its official end date—creating a new generation of health professionals fluent in digital maternal health care.
Overcoming Geography with Technology
Bhutan’s geography has always shaped its healthcare delivery. While the country has made remarkable progress in improving maternal and child health indicators over the years, disparities have persisted between urban centers and remote rural communities.
The telemedicine project directly targeted this challenge. Building on earlier digital health initiatives introduced in 2020, the program expanded nationwide coverage by deploying additional iCTG devices, strengthening referral systems, and establishing protocols for digital monitoring and consultation.
The goal was simple yet ambitious: to ensure that a pregnant woman in a remote mountain village could receive the same quality of fetal monitoring as a mother in Thimphu or Phuentsholing.
Nationwide Deployment and Capacity Building
Over the course of the project, 84 iCTG devices were delivered across Bhutan. Of these, 80 devices are now fully operational in hospitals and primary health centers, while the remaining four have been placed in teaching and training institutions to support education and skills development.
But technology alone was never the focus. Equal emphasis was placed on capacity building—ensuring that health workers could confidently and accurately use the new tools.
Doctors, nurses, and midwives across the country received hands-on training in fetal monitoring, interpretation of cardiotocography data, and decision-making based on digital assessments. This has significantly improved their ability to identify high-risk pregnancies early and respond appropriately.
To ensure long-term functionality, biomedical engineers and technicians were also trained to maintain and repair the devices locally—reducing dependence on external support and minimizing downtime due to technical issues.
Adding a global dimension to the project, selected Bhutanese health professionals and engineers participated in specialized training programs in Japan, where they gained exposure to advanced maternal health technologies and best practices. These experiences have strengthened Bhutan’s technical expertise and fostered valuable professional networks.
Early Impact: Safer Pregnancies, Stronger Referrals
Although the project has formally concluded, its impact is already being felt on the ground.
Healthcare providers report improved identification of high-risk pregnancies, allowing for timely interventions and better birth planning. With real-time data sharing, referral decisions are now faster and more accurate—ensuring that women who need specialized care are transferred without delay.
For mothers, the benefits are equally profound. The availability of digital fetal monitoring has increased confidence in antenatal services, encouraging more women to attend regular checkups. In remote areas, where access to diagnostic tools was previously limited, women can now receive monitoring comparable to that offered in major hospitals.
The project has also reduced unnecessary referrals, easing pressure on tertiary hospitals while ensuring that those who truly need advanced care receive it promptly.
A Model of International Cooperation
During the project’s closure meeting, representatives from the Ministry of Health and JICA hailed the initiative as a milestone in Bhutan’s digital health journey and a powerful example of effective international cooperation.
JICA officials highlighted Bhutan’s strong ownership of the project, noting that local leadership, commitment, and integration into national systems were key to its success. The collaboration, they said, offers a model for future health partnerships—both within Bhutan and in other countries facing similar geographic challenges.
Looking Ahead: Scaling Digital Health for the Future
The Ministry of Health has reaffirmed its commitment to sustain and expand the project’s achievements. Plans are already underway to integrate iCTG-generated data into Bhutan’s national health information system, enabling better planning, monitoring, and policy-making in maternal and child health.
The ministry also sees this project as a stepping stone toward broader digital health transformation. By demonstrating that advanced telemedicine solutions can work effectively even in challenging terrain, Bhutan has opened the door to expanding similar technologies in other areas of healthcare.
A Turning Point for Mothers and Children
The successful completion of the telemedicine project marks a defining moment in Bhutan’s ongoing effort to ensure safe motherhood and healthy childhoods for all its citizens. It shows that with the right mix of technology, training, and international partnership, even the most formidable barriers—mountains, distance, and isolation—can be overcome.
Sherab Dorji
From Thimphu
