“Good decisions come from experience, but experience comes from making bad decisions.”
The words of wisdom of American writer and humorist Mark Twain hardly fits when it comes to setting priority in the budget of Bangladesh, even in the aftermath of the novel coronavirus outbreak.
With the Covid-19 pandemic posing the biggest challenge to public health in this generation, spending more on the healthcare has been the call from economists and medical experts.
But as Finance Minister AHM Mustafa Kamal placed the proposed budget for fiscal 2020-21 in parliament yesterday, the call for prioritising healthcare fails to elicit a strong response.
The minister earmarked Tk 29,247 crore for the health ministry, an increase of 13.66 percent from the outgoing fiscal year’s allocation.
“The health sector was given utmost priority,” Mustafa Kamal said.
But his speech on giving priority does not fully reflect the reality. Because, with this allocation, the share of health budget remains below one percent of the Gross Domestic Product — only 0.92 percent, lowest compared to its peers in South Asia.
The country’s public spending on healthcare has been hovering around 1 percent of the GDP for many years, although the World Health Organization recommends it to be at least 5 percent.
Bangladesh’s healthcare system has already been struggling with the increasing burden of diseases, low quality healthcare coverage and an inadequate national budget in this regard.
As the size of the budget increased every year, the allocation for health sector rose too. But in terms of percentage of the total budget, it remained around 5 percent over the years.
It is 5.14 percent of the total outlay this time.
Unsurprisingly, out-of-pocket health expenditure for households is very high. About 65 percent of all health expenditure in the country is borne privately by households.
In the meantime, the Covid-19 pandemic has exposed vulnerabilities and systemic weaknesses in the health sector — from shortage of skilled personnel to poor infrastructure, weak monitoring and governance to inadequate coordination among key stakeholders.
There have been some recent instances where patients with flu-like symptoms and other illness were denied admission at hospitals and subsequently they died without treatment, which is a fundamental right guaranteed by the constitution.
Lifesaving machines like ventilators — critical to the management of Covid-19 cases — remain elusive and a shortage of oxygen in most of the hospitals have become a matter of grave concern.
Talking to The Daily Star yesterday, experts said the allocation for the health sector is not adequate in the wake of the Covid-19 pandemic, which served as a wake-up call to prioritise on the fragile healthcare system.
Zahid Hussain, former lead economist of the World Bank’s Dhaka office, said the allocation has not increased sufficiently.
As the health sector is facing a crisis, the government should have supported it by allocating more but that has not happened, he said in his reaction on a private television.
Prof Dr Muzaherul Huq, former regional adviser, WHO, South East Asia Region, said, “The health sector has failed. Despite past allocations of budget, the sector still remains heavily under-utilised.
“As per the last five-year plan, which is supposed to be completed this year, the health budget is supposed to be 1.12 percent of the GDP,” he said told The Daily Star.
Prof Dr Rashid-E-Mahbub, former president of Bangladesh Medical Association, said, “The problem is quite simple. The country’s health sector has not been reformed even though the sector itself has evolved over the last five to six decades.”
Both the experts noted that only increasing budgetary allocation would never solve the problems. More emphasis needs to be given on utilising the budget efficiently with ensuring proper accountability.
Management is the key issue in the sector. Shortages of nurses and medical technologists are acute at many public hospitals while equipment is available but positions of technicians are found to be vacant, they said.
Recruitment and retention are important and so are the training and professional development of health workers, they said.
Prof Muzaherul said, “As we have seen in the last five-year plan, only 24 percent had been implemented till 2019, which shows the poor performance in management and lack of management skill.”
He said there is a lack of skilled workers in the health management system of Bangladesh — both in the health ministry and the Directorate General of Health Service (DGHS). In many cases, skilled people cannot be a part of the management due to political issues.
Besides, the sector is riddled with rampant corruption, he said.
Prof Rashid-E-Mahbub said, “The health sector is now huge but its planning and monitoring remain weak. As such, concerned authorities cannot even utilise money allocated by the government.”
Public hospitals lack necessary manpower, equipment, medicine and most importantly accountability of their authorities. The general public, who have no alternative but to go to public hospitals, however, do not get proper health services, he said, adding that private medical services in the country were developed in an unregulated manner.
“The problems in the health sector cannot be solved overnight … The government should prepare a five-to-ten-year plan for the health sector considering people’s expectation and can make an outline from the National Health Policy 2011, which remains unutilised mostly,” added Rashid-E-Mahbub.
TK 10,000 CR BULK ALLOCATION
The finance minister also proposed a bulk allocation of Tk 10,000 crore to deal with any special situation related to Covid-19.
“We have taken massive steps to improve the health sector. To combat the Covid-19 pandemic, special programmes worth Tk 5,500 crore are being implemented under the Health Services Division. The government will do whatever required to address the pandemic. To fulfill emergency requirements, I propose the allocation of Tk 10,000 crore as a lump sum,” he said.
Zahid Hussain appreciated the allocation to fight the Covid-19 pandemic. “It was much needed,” he said.
TK 100 CRORE HEALTH-RESEARCH FUND PROPOSED
The finance minister also proposed the formation of a Tk 100-crore Integrated Health-Science Research and Development Fund to finance the activities for the development of research on health education, and science and technology.
A high-powered committee comprising experienced researchers in the health sector, nutritionists, public health experts, sociologists, economists, environmentalists, civil society members and other suitable representatives will be formed to manage this fund efficiently and effectively, he added.