Investigator(s)
| Submitter |
Kuenzang Chhezom Khesar Gyalpo University of Medical Sciences of Bhutan Kuenzang Chhezom 
|
| Principal Investigator |
Kuenzang Chhezom Khesar Gyalpo University of Medical Sciences of Bhutan Kuenzang Chhezom
|
| Co-Investigator(s) |
Ugyen Norbu Khesar Gyalpo University of Medical Sciences of Bhutan Ugyen Norbu
|
| Co-Investigator(s) |
Deepak Paudel Patan Academy of Health Sciences, Nepal Deepak Paudel
|
| Co-Investigator(s) |
Sudarshan Paudel Patan Academy of Health Sciences, Nepal Sudarshan Paudel
|
| Co-Investigator(s) |
Mohammad Wahiduzamman Bangladesh University of Health Sciences, Bangladesh Mohammad Wahiduzamman
|
| Co-Investigator(s) |
Mithila Faruque Bangladesh University of Health Sciences, Bangladesh Mithila Faruque
|
Title(s) and abstract
| Scientific title | Comparative Health Systems Review: A One Health Lens on Systems, Outcomes and Lessons from Bangladesh, Bhutan, and Nepal |
| Public title | South Asian Health Systems Review (SAHSR) |
| Background | Health systems of many LMICs often operate in fragmented silos, with an overly emphasis on clinical service delivery. Health policy formulation and implementation are frequently led by select decision-makers, with limited consideration of the interdisciplinary social, economic, and political determinants of health. This disconnect contributes to suboptimal and unequal health outcomes. Bangladesh, Bhutan, and Nepal—three South Asian nations—share cultural and geographic ties but differ markedly in their health systems and service delivery models. Bangladesh, with its dense population and strong NGO presence, has built a robust network of community health initiatives. Bhutan provides fully government-funded healthcare, integrating traditional medicine and ensuring universal access to healthcare. Nepal emphasizes community-based primary care while managing both infectious and non-communicable disease burdens. A comparative review of these countries through a One Health interdisciplinary lens, using participatory mixed-methods, reveals shared challenges and unique innovations. This approach promotes cross-learning and highlights opportunities to strengthen health systems by integrating human, animal, and environmental health, ultimately advancing resilience and equity across the region. |
| Objectives | General Objective ● To conduct an interdisciplinary review of the health systems of Bangladesh, Bhutan, and Nepal through a One Health lens, examining their structures, delivery mechanisms, outcomes, and contextual dynamics. Specific Objectives ● Assess health system performance across Bangladesh, Bhutan, and Nepal in terms of service delivery, quality of care, equity, and health outcomes. ● Examine trends in health investment and outcomes from a systems perspective, identifying pathways toward achieving the Sustainable Development Goals (SDGs). ● Identify opportunities and challenges within each country’s health system, with a focus on multisectoral integration, resilience, and One Health approaches. |
| Study Methods | Research design: Mixed-method study using desk review of policies, secondary data, key informant interviews, field observations and validation workshop. Desk review: A desk review of national health policies (~4 key policy documents, including one focusing on the One Health Strategy) will be reviewed. A policy review checklist will be prepared to assess the healthcare delivery, health financing, and healthcare quality approaches. The review will also analyze the integration of the interdisciplinary One Health approach. Secondary data review: Secondary health outcomes data for 1990-2025 will be reviewed for all three countries, focusing on key health systems indicators such as life expectancy, infant mortality rate, maternal mortality rate, and health expenditure per capita and SDG3 indicators. Key Informant Interviews (KII): About 12 key informants in each country representing academia, government, civil society and community will be interviewed using the pre- defined KII checklist. The team from the other country will lead data collection to minimize bias and introduce new perspectives. |
| Expected outcomes and use of results | This study would provide a baseline data on the one Health situation in the countries which would support strengthening the health systems pertaining to one health in these countries |
| Keywords | health systems review |
Research Details
| Student research | No |
| Start Date | 01-May-2026 |
| End Date | 31-Dec-2026 |
| Key Implementing Institution | Khesar Gyalpo University of Medical Sciences |
| Multi-country research | Yes |
| Bhutan, Bangladesh, Nepal | |
| Nationwide research | Yes, with randomly selected geographical areas |
| Bhutan, Bangladesh, Nepal | |
| Research Domain(s) | Non-communicable diseases & Healthy Lifestyles |
| Research field(s) | Health Financing |
| Involves human subjects | Yes |
| Health System and Policy Research | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | Approved |