According to the most recent national census conducted in 2017, Bhutan had a population of 727,145 inhabitants, unevenly distributed across the country, with a significant share living in rural and remote mountainous areas. In this context, ensuring equitable access to healthcare remains a persistent challenge. Rugged mountains, deep valleys, dispersed settlements, and limited transport connectivity significantly affect how easily people can reach medical services. Delays can mean the difference between timely treatment and preventable complications, particularly for maternal emergencies, acute infections, and chronic disease management.
To address this challenge, the European Space Agency, through its Global Development Assistance (GDA) Public Health activity, partnered with the Asian Development Bank, the Ministry of Health, Royal Government of Bhutan and Diginove to develop an Earth Observation (EO)-based service supporting telemedicine deployment. The initiative integrates satellite data, national datasets, and geospatial modelling to map population distribution, healthcare facilities, and travel times under realistic terrain and transport conditions. This spatial evidence base helps identify where telemedicine can most effectively reduce geographic barriers and strengthen connections between isolated communities, local health centres, and hospital-based specialists.
Close collaboration with ADB specialists and Bhutanese stakeholders ensured the EO products addressed operational needs, delivering validated, decision-ready insights for planning, resource allocation, and targeted digital health investments.
When Geography Shapes Access to Care
Bhutan’s healthcare system has expanded considerably, with over 240 health facilities distributed nationwide. However, physical geography continues to impose constraints, particularly in remote areas where settlements are located in steep terrain and often require walking long distances before reaching a road. Seasonal hazards such as landslides or snowfall can further disrupt connectivity.
As a result, accessibility is not simply a matter of distance. Travel time is shaped by terrain, infrastructure, and available transport options. This is especially relevant for specialised hospital care, which is concentrated in fewer locations.
Why Earth Observation Matters
Earth Observation provides a consistent, nationwide evidence base that complements existing health information systems and other data sources. Satellite imagery enables spatial granularity for the identification of settlements, land cover classification, and population modelling in areas where field data collection is limited.
In the Bhutan case study, EO forms the backbone of an integrated analytical framework combining population estimation, terrain-aware accessibility modelling, and service delivery analysis at scales relevant to health planning. This approach highlights where healthcare access is strong, where it is constrained, and where telemedicine can provide the greatest benefit.
Turning Satellite Data into Health Intelligence
A) Mapping Where People Live
The first component focused on understanding population distribution. Using recent Copernicus imagery, settlement footprints were extracted and combined with open-source data and census totals through demographic modelling. This produced a spatially detailed population estimate for 2025, capturing both urban concentrations and dispersed rural communities.
B) Modelling Realistic Access to healthcare
The second component assessed how easily populations can reach healthcare services under real-world conditions. The analysis used a hybrid travel scenario reflecting typical patterns in Bhutan: people walk across terrain to reach the nearest road, then continue using motorised transport.
Slope effects were incorporated to account for variations in walking speed due to terrain steepness. Water components such as rivers and lakes are considered impassable barriers for travel in both Walking and motorised modes. This ensures that travel times more accurately reflect the country’s landscape and mobility constraints.
C) Revealing the Gap between Basic and Specialised Care
The service distinguishes between two accessibility scenarios:
- Access to all healthcare facilities (primary care network): gives a picture of how well Bhutan’s PMCs serves the population
- Access to hospitals (specialised care): shows where people face greater difficulty reaching advanced or referral-level care.
This distinction highlights how primary healthcare centres help mitigate geographic barriers, while also revealing remaining challenges in accessing hospital-level services.
Key Insights: What the EO Analysis Reveals
A) Strong primary healthcare coverage: Most of the population can reach basic services within relatively short travel times, suggesting Bhutan’s primary care network effectively provides first-contact care and could serve as an anchor for telemedicine hubs.
B) Uneven access to hospital-level care: Remote mountainous regions experience significantly longer travel times to specialised services, creating risks for delayed diagnosis, emergency referrals, and continuity of care for chronic conditions requiring specialist management.
C) Spatial disparities across districts: Central areas benefit from better accessibility, while remote regions face greater constraints.
D) Priority communities identified at local level: Areas such as Lunana, Lauri, Laya, Serthig, and Tsamang show the greatest access limitations and are strong candidates for telemedicine deployment.
Targeting Telemedicine Where It Has the Greatest Impact
EO-based accessibility analysis enables targeted telemedicine planning by identifying areas where travel times to hospitals are highest. In these locations, telemedicine can strengthen connections between populations and health centres, as well as between primary health care providers and specialists, supporting diagnostic consultations (e.g., radiology reads, ECG interpretation), chronic disease monitoring (e.g., diabetes, hypertension follow-up), maternal and newborn care (antenatal consultations, postnatal check-ins), and clinical referral decisions – bringing specialist expertise closer to communities. This reduces the need for long-distance travel, along with associated transport-related emissions, while improving continuity of care and overall system efficiency.
Unlocking Broader Value for Health Planning
Beyond telemedicine, the EO-derived datasets support wider decision-making across sectors. They can inform infrastructure planning, resource allocation, referral system design, and emergency response strategies, particularly in remote and high-risk areas.
Building Sustainable and Transferable Solutions
In Bhutan, EO services support the identification of priority areas for telemedicine under the ADB initiative, guiding investments where needs are greatest. Based on transparent methods and globally available datasets, the approach is transferable to similar contexts and can be updated over time as infrastructure and population patterns evolve.
Key Takeaways
- ESA’s GDA Public Health programme, in collaboration with ADB, the Ministry of Health of Bhutan, and Diginove, developed EO-based services to support telemedicine planning.
- The approach combines satellite-derived settlement mapping, population modelling, and realistic travel-time analysis.
- Results confirm strong primary health care coverage but highlight persistent gaps in access to hospital-level services in remote regions.
- District- and block-level analytics identify specific underserved areas, including Lunana, Lauri, Laya, Serthig, and Tsamang, as strong candidates for telemedicine deployment.
- The methodology provides a scalable, updateable, and replicable approach that can support longer-term health planning in Bhutan and be adapted to other countries facing similar geographic constraints.
Acknowledgment
The present work was carried out in close collaboration with the ADB and Ministry of Health personnel. We acknowledge the Asian Development Bank team, including Yves Barthelemy, Sonalini Khetrapal, Romelei S. Camiling-Alfonso, and Jae Kyoun Kim, as well as Kinley Dorjee from the Ministry of Health,Bhutan for their collaboration and support throughout this case study.
