A tug of war between two ministries over World Bank loan of Tk 25.5b

A tug of war is ongoing between the local government ministry and the health ministry over taking charge of primary healthcare services in all city corporations including Dhaka.

This situation has surfaced over a loan of $ 300 million offered by the World Bank for the development of urban health services in Bangladesh. The bone of contention is which ministry will spend the money.

The health ministry is in charge of health services in the rural areas including community clinics, mother and children care centres, union health and family welfare centres and upazila health complexes.

On the other hand, the local government ministry is given the responsibility of urban health services through the City Corporation Law in 2009. However, there is a discontent among different quarters over the urban health services.

Experts said the health services in the rural areas have significantly improved in the last one decade. On the contrary, the urban health services have not improved during the same period as per the expectation.

Even the officials of local government division admit that. They say the poor people have to go to government hospitals or nearby pharmacies for emergency treatment.

Under such a situation, the WB wants to give a $ 300-million loan for the development of health services in all the city corporations including Dhaka.

Dandan Chen, the acting head of the World Bank in Dhaka, has been holding meetings with the officials of the health ministry for two months. In those meetings, the World Bank wanted to know which ministry will be in charge of urban health services.

It is learned that the health ministry wants to deliver health services in the urban areas like the rural areas. According to the existing city corporation law, it is impossible Therefore, the law on city corporations and municipalities has to be amended in order to provide health services through the health ministry.

If this is not possible, the services of 17 government pharmacies (GODs) under the health ministry can be extended to provide primary health services in Dhaka city. Otherwise, the primary health services can be provided by constructing separate infrastructure next to the big hospitals in Dhaka.

On the contrary, local government ministry officials have said that it would not be right to put urban primary health services under the health ministry.

As a result, a tension has surfaced between the two ministries over this issue.

Speaking to Prothom Alo, local government ministry senior secretary Helal Uddin Ahmed said city corporations around the world deliver urban health services including street lights, sewerage and sanitation. The law has given the responsibility of doing these things to the local government department.

And the responsibility of the health ministry is to ensure health services in big hospitals at district, upazila and union level. They do not have any scope of providing urban health services.

Helal Uddin Ahmed said, “It’s true that the urban health services did not improve much in the last decade. However we are working on this. We are discussing this with the health ministry. We will construct the ward-based infrastructures. The health ministry will provide the health services.”

When asked, former advisor to the caretaker government, Hossain Zillur Rahman said, "This is a wrong thinking as to which ministry will be in charge of the urban health services. The bureaucracy has created this."

By changing their thinking, the two ministries can easily solve this problem if they want and the scope of work here is so extensive that both the ministries can work.

He also questioned what the local government division has done in the last one decade after getting the responsibility of the urban health services.

A project titled 'Urban Primary Health Care Services Delivery' has been running under the local government division since 1998. The project, funded by Asian Development Bank (ADB), has not yielded expected results.

According to the health ministry officials, around 20 million people live in the capital. However, the institutes under the local government do not have any health unit to serve this huge population. There is a lack of technical knowledge, infrastructure and manpower to provide these services as well. There is even no separate financial account for health services in the pourashavas (municipalities) and city corporations of the country.

When asked, Helal Uddin, additional secretary of the health ministry, said, the health ministry wants to enhance its participation in the urban primary health services. However, there are legal complexities in this context. For this reason there should be discussions among the policymakers regarding the health services.

*This report originally appeared on the print and online versions of Prothom Alo and has been re-written in English by Ashish Basu