Sangay Thinley¹, Tshering Gyeltshen²

¹Traditional Medicine Unit, Eastern Regional Referral Hospital, Mongar, Bhutan

²Traditional Medicine Unit, Trashigang Hospital, Trashigang, Bhutan

Corresponding author: Sangay Thinley, Traditional Medicine Unit, Eastern Regional Referral Hospital, Mongar, Bhutan.

Email: sangayt@mrrh.gov.bt

DOI: https://doi.org/10.47811/bsj.0017061111

Dear Editor,

Across the globe, despite limited evidence of full scale collaboration, integrating traditional medicines with biomedical medicine has demonstrated improved healthcare outcomes. In African countries like Kenya and Ghana, the integration of traditional medicine with modern healthcare has enhanced patient outcomes while preserving cultural heritage [1]. This holistic approach has increased the accessibility and acceptance of healthcare services, particularly in rural areas [1]. In China, neurologists in collaboration with traditional health workers, often use Traditional Chinese Medicine for rehabilitative care [2]. This integration between the two systems has led to a more comprehensive and effective care for patients.

Bhutan offers free healthcare, integrating Traditional Medicine with modern biomedicine with the aim of improving health outcomes in patients [3]. Free health services of both systems are mandated by Article 9, section 21 of the Constitution [4], and is emphasized in the National Health Policy 2012 [3].

To foster collaboration between the two sectors, Bhutan has developed a Traditional Medicine Guideline that outlines the partnerships between traditional and allopathic practitioners. For instance, the Local Healing Division collaborates with the Mental Health Program under the Department of Public Health, while Drungtshos at the National Traditional Medicine Hospital, Regional and District Hospitals coordinate with allopathic doctors for cross-referral of patients and clinical consultation [5]. However, despite policy-level integration, evidence of effective collaboration between traditional and modern health workers remains limited. There is no clear guideline for patient referrals, and clinical areas of collaboration lack clarity.

This Letter summarizes the findings on collaboration between the two sectors in patient referral, and knowledge sharing. This is based on the survey of practices in eight hospitals, involving 38 doctors, 43 health assistants, 21 Drungtshos, and 37 Menpas in 2019. The hospitals included the National Traditional Medicine Hospital and the Jigme Dorji Wangchuck National Referral Hospital, Central and Eastern Regional Referral Hospitals and district hospitals in Paro, Bumthang, Zhemgang, and Samtse.

Seventy one percent (71.4%) of allopathic health workers and 63.6% of Traditional Medicine service providers reported having cross-referred patients to other sectors, Figure 1. Only 12.4% of allopathic workers viewed Traditional Medicine as both effective and free of side effects while, 36.2% of Traditional Medicine practitioners recognized allopathic medicine as effective, and 22% considered it effective only for specific diseases. Among allopathic workers, 40.7% saw Traditional Medicine as equally important, while 79.3% of Traditional Medicine practitioners viewed allopathic medicine as superior. The majority of the practitioners (over 96%) in both systems respected each other’s professions, valuing dedication, knowledge, and expertise

The areas of collaboration is summarized in Figure 2. Sixty-six percent (65.5%) of Traditional Medicine practitioners and 56.8% of allopathic workers had attended knowledge sharing sessions. Majority of the survey participants reported collaborations on hospital administration (37.3%), and hospital policy related matters(19.5%) but had low volumes of discussion on collaboration in management of diseases (18.2%). Additionally, 58.9% of participants reported a lack of effective system for sharing knowledge and information across to the other sector.

Integration of traditional and modern medicine would harness the strengths of both systems, offering holistic care for patients that addresses physical and mental needs. To optimize patient outcomes, structured referral pathways, cross-system training programs, and a robust system for sharing clinical knowledge and treatment practices between the two systems is highly recommended.

Acknowledgements

We thank Deki Wangmo, Khesar Gyalpo University of Medical Sciences of Bhutan, Karma Galey, and Tempa Gyeltshen for their guidance. Special thanks to Dorji Pelzom, statistician at the Ministry of Health, and Mongal Singh Gurung, research officer, for his valuable help in development of the study questionnaire. We express heartfelt appreciation to all who assisted in the data collection.

Declarations

Ethics approval was obtained from the Research Ethics Board for Health, Ministry of Health, Bhutan (REBH/Approval/2018/029; Approval Date: 14th June, 2019). Administrative approvals were granted by the Policy and Plan ning Division, Ministry of Health, and respective hospital administrators.

Consent for publication

Not applicable

Competing interests

None

This study was funded by the Ministry of Health, Royal Government of Bhutan. However, the funder was not involved in the design and conduct of this study.

There dataset is available from the corresponding author upon request.

Conceptualization, data curation, methodology, resources, review and editing, analysis, writing original draft, validation: ST, TG

References

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3. Ministry of Health. National Health Policy 2012. Thimphu: Ministry of Health, Royal Government of Bhutan. 2012. https://moh.gov.bt/wp-con tent/uploads/2025/01/National-Health-Policy.pdf
4. Royal Government of Bhutan. The Constitution of the Kingdom of Bhu tan. Thimphu: Royal Government of Bhutan. 2008. https://www.rcsc.gov. bt/wp-content/uploads/2021/02/Constitution-of-Bhutan-Eng-2008.pdf
5. Ministry of Health. Guideline for Collaboration of Traditional Medicine and Modern Medicine. Thimphu: Ministry of Health, Royal Government of Bhutan, Thimphu