Hospital rooms neatly arranged but no medical equipment, project stops midway

While visiting Bangladesh Shishu Hospital and Institute in the capital’s Agargaon area last Sunday, a separate room prepared in a wing on the ground floor of the building came to notice. Though neatly arranged, the room was empty.

When asked why it was empty, hospital officials explained that the room was intended to house a high dependency unit (HDU) for providing emergency care to children. While the room was built under a government project, the necessary medical equipment was never delivered. So the HDU could not be made operational.

Director of Bangladesh Shishu Hospital and Institute Md Mahbubul Hoque told Prothom Alo that at least Tk 40 million (Tk 4 crore) is required to purchase equipment for the HDU and make it operational.

According to him, the hospital authority does not have that much money. If the unit were functional, it would greatly benefit the patients. For now it remains unused, he added.

The project under which the HDU was to be set up at the Shishu hospital was initiated during the COVID-19 pandemic as part of efforts to combat it. The project was titled ‘COVID-19 Emergency Response and Pandemic Preparedness’. The total budget for the project was set at Tk 63.86 billion (Tk 6,386 crore).

Of this, Tk 59.14 billion (Tk 5,914 crore) was provided as loans by the World Bank and China-initiated the Asian Infrastructure Investment Bank (AIIB). The remaining Tk 4.72 billion (Tk 472 crore) was covered by the government of Bangladesh.

However, the World Bank withdrew from the project in December last year as allegations were raised of corruption during the tenure of the Awami League government, which was overthrown in the July mass uprising that year.

Shortly after the World Bank’s exit, the government declared the project concluded midway.

As a result, various healthcare infrastructures in different hospitals including the Shishu hospital have been left incomplete. In many cases, only the structures have been constructed, but no equipment was delivered. So, despite the enormous expenditure, people are not receiving the intended healthcare services.

Additional director general (planning and development) at the Directorate General of Health Services (DGHS), Sheikh Sayidul Haque told Prothom Alo that they are having to conclude the project leaving the remaining work unfinished. The remaining funds are being returned. When asked about the reason behind this decision, he replied, “It’s a government decision.”

According to DGHS data, Tk 47.19 billion (Tk 4,719 crore) had been spent under the project till December last year, leaving 16.67 billion (Tk 1,667 crore) unused. The project was originally scheduled to conclude next month (June), but it was declared concluded ahead of time.

Why did the World Bank back out from the project was asked at the organisation’s Dhaka office. In a statement sent to Prothom Alo on 8 May, acting country director of the World Bank in Dhaka Gayle Martin said that the World Bank takes allegations of fraud and corruption in any of its funded projects very seriously. Whenever the World Bank receives credible evidence of corruption or fraud, it immediately forwards the information to the relevant government authorities, it added.

Gayle Martin stated that the World Bank shared the findings of its own investigation into this project with the government, which were later forwarded to the Anti-Corruption Commission (ACC).

She added that the government would now use its own funds to complete the remaining parts of the project. However, the government has declared the project concluded without completing it under domestic financing.

Bangladesh detected its first COVID-19 case on 8 March 2020. When fears of a large-scale outbreak arose, the World Bank stepped in with loan assistance. Then arrangements were made for purchase of protective equipment under the COVID-19 Emergency Response and Pandemic Preparedness’ project. Plus, efforts were made to strengthen medical infrastructure, which was expected to benefit the healthcare system not only during the pandemic but in the long term as well.

However, noticeably the three-year project has not been completed even after five years. The project director has been replaced six times, and it was plagued by widespread allegations of irregularities and corruption.

Irregularities in procurement under this World Bank-funded project came to light through an audit conducted by the foreign aided projects audit directorate in 2023. Based on that audit, the Implementation Monitoring and Evaluation Division (IMED) of the Planning Ministry prepared a report, which is scheduled to be published next month.

The report states that the government’s public procurement rules (PPR) was violated to buy equipment at higher prices during the procurement of the COVID-19 preparedness project. Contracts were given to inexperienced and unqualified firms. Substandard materials were procured without proper quality checks. There was ‘negligence’ on the part of the then responsible officials at the Directorate General of Health Services in doing so, the report pointed out.

Personal protective equipment (PPE) and masks were the most essential to prevent COVID-19 back then. Due to a shortage of these two protective items, physicians initially struggled a lot in providing treatment. There have been irregularities in the procurement of these two items. The IMED report states that there was a discrepancy of nearly Tk 340 million (Tk 34 crore) in the accounts related to the purchase of PPE, masks, and infrared thermometers used for measuring body temperature.

An official involved with preparing the IMED report told Prothom Alo that the discrepancy refers to the fact that the DGHS is unable to confirm two pieces of information regarding whether they have actually received the protective equipment worth nearly Tk 340 million (Tk 34 crore) or not and if they have where were theose distributed.

The report reveals that the then DGHS officials had signed contracts with unqualified and inexperienced suppliers for the purchase of PPE, masks, and hand gloves. This cost the government nearly Tk 590 million (Tk 59 crore) extra.

When a project is funded by foreign loans, it is audited by the foreign aided projects audit directorate of the government. The agency raised 76 audit objections involving Tk 4.65 billion (Tk 465 crore) over five years from 2020 to 2024 under the ‘COVID-19 Emergency Response and Pandemic Preparedness’ project. This implies that government rules were not followed in spending this amount of money, and there are discrepancies in this expenditure.

But the DGHS says that eight of these audit objections involving Tk 800 million (Tk 80 crore) have already been resolved. Meanwhile, the remaining 68 objections involving Tk 3.85 billion (Tk 385 crore) are left unsettled.

When this was brought to the attention of additional director general (planning and development) at the DGHS, Sheikh Sayidul Haque, he told Prothom Alo, “IMED has pointed out some flaws of the project in their report. However, we haven’t received the report yet. There have been several audit objections, some of which have been resolved. If the rest cannot be settled, whatever action is prescribed in the law, will be taken.”

The IMED report also noted that essential medical supplies worth Tk 3 billion (Tk 30 crore) were purchased on an emergency basis under the project, but those remained unused and did not benefit the public.

Under the COVID-19 preparedness project, a one stop emergency and casualty (OSEC) unit was established at the Shishu Hospital. It was supposed to provide all emergency services for paediatric patients in one place. The HDU was a part of that. There are two more rooms for X-ray and ultrasound services as well. However, neither of these two rooms is operational for there is no equipment.

As part of the same project, a 21-bed emergency and referral room has also been set up at the hospital. No equipment was provided for it either. Later, the Shishu hospital authorities opened the room using their own funds to offer emergency care to patients. They do not have the money needed for making the other units operational.

Under this project, 20-bed isolation units were to be setup in 50 of the district hospitals with the total number of 1,000 beds. The IMED report states that the infrastructure for these units has been built in 47 district hospitals so far. However, not even a single one of them has been supplied with medical equipment. So the buildings are left empty and unused.  

In addition to that, 10-bed intensive care units (ICUs) were also supposed to be established in each of those 50 district hospitals. So ICUs have been set up in 48 of the 50 hospitals accordingly. However, ICU equipment has been supplied to only 13 of them. Tenders could not be called for the procurement of equipment for the remaining 35 hospitals. So, those ICUs are not coming to any use.

Pediatric care units were also established in 14 medical college hospitals, but tenders for equipment procurement are yet to be called. Speaking on condition of anonymity, a director of one of the hospitals told Prothom Alo that they have heard the World Bank withdrew from the project due to allegations of corruption for which the public has to pay the price.

Moreover, obstetric intensive care units (OBS-ICUs) were supposed to be established in 14 more medical college hospitals as well as at the Institute of Child and Mother Health in Matuail. While the infrastructure has already been constructed in these facilities, no equipment has been procured.

Plus, medical waste management plants were supposed to be setup in 20 hospitals. Construction has been completed in 16 of them, with work still ongoing in four. However, the equipment procurement process has been cancelled.

There are several other cases where the construction part of the healthcare system has been completed without the purchase or delivery of equipment. So there has arisen a concern that the funds already spent on these projects may go to waste.

Some work has actually been completed under the COVID-19 pandemic preparedness project though. For example, 68 million (6.8 crore) doses of COVID-19 vaccines were purchased, along with 110 (11 crore) million syringes.

Some oxygen supply equipment was supplied to hospitals, liquid oxygen supply systems were installed in 30 government hospitals, as well as huge quantities of PPE, COVID-19 testing kits, and masks were procured. However, allegations were raised of corruption and irregularities in the procurement.

In some cases, the healthcare systems developed under the project are not coming to any use or remains out of order. The IMED report stated that the ICU built at the 250-bed general hospital in Tangail is out of order. Meanwhile, an ICU has been set up at the 250-bed general hospital in Jashore but has not become operational yet.

According to sources at the health ministry, there have been several meetings at the ministry to discuss on necessary measures needed to complete the remaining works of the project. There have been discussions about launching a new project to complete the unfinished work. However, there has been no final decision yet.

On 10 May, professor Syed Abdul Hamid of the institute of health economics at Dhaka University told Prothom Alo that it was not right to declare the project concluded leaving work unfinished like this. If the infrastructure is complete and not made operational, it will go out of order over time. The government should continue the project using its own funds.

He added that it’s already established that there has been corruption in this project. Those involved in this must be brought to justice. However, the remaining work must be completed before that to ensure that people receive the healthcare services.