Despite the government’s sustained efforts to recruit foreign nurses, the initiative has so far yielded limited results. In light of this, the Ministry of Health (MoH) is now reassessing its approach and implementing a revised strategy to make the recruitment process more effective and appealing to international candidates. As part of this strategic shift, the MoH is introducing a more competitive package of incentives, which will include better remuneration, accommodation support and others. These enhanced benefits are aimed at positioning Bhutan as a more attractive destination for skilled foreign healthcare professionals, particularly in light of increasing global demand for nurses.
With the goal of recruiting at least 45 foreign nurses by March 2025, the MOH—supported by the Royal Bhutan Consulate in Kolkata—recently initiated its first round of recruitment. Vacancies were advertised in The Telegraph newspaper in Kolkata, a move aimed at reaching qualified nurses across India. However, the initiative received no applications, highlighting the challenges Bhutan faces in a highly competitive regional and global job market.
In response to this unexpected setback, the ministry has revised its approach. “A new proposal with improved incentives was submitted to the Ministry of Finance and has been approved,” said a MoH official. The updated package includes housing support and additional allowances designed to make the positions more attractive to foreign candidates.
The plan to recruit foreign nurses has been part of the ministry’s long-term strategy to address the critical shortage of nursing staff, particularly at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). In the face of shortages, there is immense pressure on the existing work force. However, previous recruitment efforts faced hurdles due to concerns over a roughly 30% salary gap between foreign and local nurses.
Ministry officials clarified that while foreign nurses may earn more on paper—up to Nu 8,495 extra per month for those with six to ten years of experience—they are not entitled to long-term welfare benefits, retirement pensions, or the structured career progression available to Bhutanese civil servants. “This recruitment is a temporary measure to fill urgent workforce gaps, not a long-term replacement strategy,” the official added.
To confront the pressing issue of wage disparity and bolster retention of domestic healthcare professionals, the National Medical Services (NMS) has proactively submitted a comprehensive proposal to the Royal Civil Service Commission (RCSC). This strategic initiative is designed not only to address immediate compensation concerns but also to reshape the career landscape for Bhutan’s healthcare workforce.
At the heart of the proposal is the introduction of an alternative career pathway tailored specifically for healthcare professionals. This pathway aims to provide clearer, more diverse avenues for career progression beyond traditional roles, recognizing the unique skills and contributions of medical staff at various levels. By creating specialized tracks that allow for both clinical and administrative advancement, the system hopes to motivate healthcare workers to remain engaged and committed to their professions over the long term.
Equally significant is the proposal’s emphasis on a performance-based advancement system. Through these reforms, the NMS aims to reduce the widening wage gap that has contributed to the migration of skilled workers and the erosion of morale within the sector. The proposed career and advancement framework is intended to make Bhutan’s healthcare profession not only more financially competitive but also more fulfilling and sustainable as a lifelong career.
“This initiative is intended to ensure fair recognition, career progression, and improved morale among local health workers,” said the official.
Bhutan is far from alone in facing the challenge of nursing shortages. Around the world, well-trained and experienced nurses have become some of the most sought-after professionals, a demand fueled by multiple converging factors. Rising rates of non-communicable diseases such as diabetes, heart disease, and cancer require ongoing, specialized care. At the same time, aging populations in many countries increase the need for skilled nursing support to manage chronic conditions and provide compassionate long-term care. This global surge in healthcare demands has intensified competition among nations to recruit and retain qualified nursing staff, making the battle for talent increasingly fierce.
“We are competing with high-income countries such as the UK, USA, Australia, and GCC nations, all of which offer more lucrative packages and better professional opportunities,” the official acknowledged.
Despite the ongoing pressures on the healthcare workforce, recent data suggest a tentative stabilization in nurse attrition rates. After peaking at 16.1% in 2023, the attrition rate has declined to approximately 11.6% in 2024. While no formal research has yet been conducted to pinpoint the exact causes of this shift, officials speculate that stricter immigration policies in key destination countries—where many nurses seek employment opportunities abroad—may have played a significant role in temporarily slowing the outflow of healthcare professionals. This trend, though encouraging, remains fragile and underscores the need for sustained efforts to improve retention and workforce resilience domestically.
In the meantime, to partially bridge the staffing gap, the MoH has introduced the Extended Clinical Services (ECS) program at JDWNRH. Although not designed as a long-term retention strategy, ECS provides additional allowances to nurses and operating theater staff working extended hours. “The program is aimed at ensuring continuous service delivery, especially in critical care units,” the official said, noting that ECS has significantly improved service delivery and patient care at the national referral hospital.
The Ministry of Health officially announced its foreign nurse recruitment initiative during a recent Meet the Press session, marking a critical step toward addressing the country’s growing healthcare workforce challenges. Health Secretary Pemba Wangchuk drew attention to an alarming 30% attrition rate among nurses at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), the nation’s largest and busiest medical facility.
This high turnover rate has placed tremendous strain on essential departments, including emergency, intensive care, and surgical units — areas that require constant staffing and high levels of expertise. The shortage has not only increased the workload for existing nurses but has also begun to affect the quality and continuity of patient care. There is an urgent need to ease this pressure and maintain uninterrupted health services.
The government has approved the recruitment of 145 foreign nurses in three phases. They will be deployed at various departments under JDWNRH and the Gyaltsuen Jetsun Pema Mother and Child Hospital (MCH). These nurses will be offered two-year contracts with monthly salaries ranging from USD 800 to USD 1,000 (approximately Nu 66,000 to Nu 80,000).
As Bhutan continues to grapple with the complex and evolving challenges of sustaining its healthcare workforce, the success or failure of this renewed effort to recruit foreign nurses will serve as a crucial benchmark—testing the nation’s capacity to adapt, innovate, and remain resilient within an increasingly competitive global health labor market.
This initiative not only represents Bhutan’s urgent and pragmatic response to the current shortage of healthcare workers but also highlights a deeper, long-term imperative: to strengthen and future-proof the nation’s healthcare system in the face of mounting global challenges. These include the increasing migration of skilled healthcare professionals to more lucrative markets, the rapid growth of aging populations requiring complex and specialized medical care, and the escalating demand for advanced health services to manage chronic and non-communicable diseases. By addressing these interconnected issues proactively, Bhutan aims to build a resilient health workforce capable of meeting both present and future healthcare needs.
Nidup Lhamo from Thimphu
