Quality as part of universal health coverage in Bhutan: a narrative synthesis

Quality of care is fundamental for countries' progress towards universal health coverage (UHC). While access to health care and financial protection have received substantial attention in both global- and country-level discussions and monitoring systems, attention to quality of care in the context of UHC has remained rather limited. Through a combination of document analysis and narrative synthesis approach, this study describes and synthesizes the existing evidence on quality of care in Bhutan, in the context of its progress toward UHC. The results suggest that while the population health outcomes have improved, there are significant shortfalls in care competencies, and a need to strengthen the quality foundations through system-wide action. Specific attention needs to be paid to key quality imperatives such as strengthening governance mechanisms, enhancing clinical competency with measurable quality indicators, streamlining patient flows in primary and specialist care, and addressing the urgent gaps in the health care workforce.