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Bhutan is currently transforming its health system and has updated its Health Technology Assessment (HTA) framework. This revision is designed to prioritize health initiatives and ensure the sustainability of the health system. The framework outlines the stages of the HTA process and identifies the stakeholders with their roles and responsibilities. The framework has been contextualised to Bhutan’s needs and has been endorsed by the high-level decision-making authority for the health sector. The experience highlights diverse challenges and solutions including international collaborations for the institutionalisation of HTA and the lessons learned from this process offer insights for HTA efforts in other settings.