Positioning Nurses in Primary Health Care in Bhutan

Introduction: Nursing in Bhutan had its beginning in the early 1960s, approximately 20 years prior to the Alma Ata Conference. From basic nursing care and housekeeping roles, Bhutanese nurses have now occupied central place in nursing service, administration and management and education. Nursing education has progressed from certificate level in the 1960s to bachelor, master and PhD levels in 2014. Although nurses have been closely associated with Primary Health Care development in Bhutan, apart from the role of the Auxiliary Nurse Midwives, nurses have rarely been explicitly associated with this area of practice. Therefore, the objective of this study was to find out the role of Bhutanese Nurses in PHC. Methods: qualitative case study method was used to carry out focus group and in-depth interviews with 66 respondents that included policy makers, planners, educators, regulators and implementers. Data were analyzed through manifest and latent content analysis. Results: The centrality of the nursing role in the area of PHC has not been realized. Discharge of the PHC role was identified more in terms of the place of work and by title or designation of the nurses. Primary Health Care momentum appeared to have slowed down and nurses differed in their understanding of PHC concept. Conclusion: Although Nursing in Bhutan has made much progress, the uneven development of the nurses’ role in PHC in Bhutan and globally suggests a need to identify and implement strategies such as standardizing, role profiling, curricula review and leadership improvement to ensure progress in this area.