Health sector deprived for over a decade

In terms of money, allocations have increased over the past 10 years in the health sector. But the slice for this sector in the national budget has shrunk. During this span of time, several ministries have been given a fatter cut of the budget, but this essential sector has seen nothing but deprivation.

Over the past year, the budget allocation for this sector decreased from just over 6 per cent to less than 5 per cent. The health sector budget allocation in the current fiscal is not even 1 per cent of the GDP. And this ratio is on a downward trend.

An overview of the health sector budget in the past few years reveals that over half of the allocation is spent on salaries and allowances, drug and medical equipment procurement and operational costs. The rest is kept for development. And half of that development allocation is used on construction of buildings an all sorts of big infrastructural projects. Hardly any is left for research and basic improvement in health services.

According to the World Health Organisation (WHO) website, Bangladesh lags behind among other South Asian countries in per head allocation of the health sector. The allocation per head in Bangladesh’s health sector is just $88. Pakistan’s per head allocation for health is $129 and India’s is $267. Maldives has the highest allocation of nearly $2000 per head. Next is Sri Lanka at $399. The United States has the highest per head health allocation in the world, nearly 107 times that of Bangladesh.

According to experts and researchers, the budget allocation for the health sector in Bangladesh is typically conventional and even desultory. Executive director of the think-tank Centre for Policy Dialogue (CPD), Fahmida Khatun, speaking to Prothom Alo, said that the budget allocation for the health sector is way below requirement.

Professor of Dhaka University’s department of health economics, Syed Abdul Hamid, said that the increases being made in the budget allocation ever year basically goes to salaries and allowances, drugs and other medical items, as well as construction and maintenance. Those in the health directorate who draw up the budget, do not take the actual requirements into cognizance. They simply add 5 to 10 per cent to the previous year’s budget. Again, many do not have the know-how of effective expenditure. A chunk of the budget remains unutilised. He said, “The health directorate and ministry do not have qualified persons to prepare a proper budget.”

Budget over the past decade

The current financial year’s budget allocation for the health sector, was triple that of the 2010-11 fiscal. But then, in these 10 years, the size of the budget has increased almost 4.15 times.

Every year when the budget is announced, allocations are made for 15 sectors. The finance ministry’s budget files reveal that in 2010-11, the health sector ranked at the 9th place, with a 6.2 per cent allocation. In the current 2019-20 fiscal, the sector ranks at 11 among the 15 sectors, with a 4.9 per cent allocation. Over these past 10 years, budget allocations have increased in the education, communications, energy and a few other sectors.

The budget allocation is divided into two sectors – development and operational, that is, non-development. The Annual Development Programme (ADP) is run on the development budget. And the non-developmental budget is used for operational expenditures such as salaries and allowances and procurement of drugs, other items and such for government hospitals and community clinics.

In the current fiscal, the ministry, the health services division and the health education and family welfare division, received an allocation of Tk 257.33 billion. Of this, Tk 134.66 was or operational costs, that is, around 53 per cent of the health sector budget. About one-fourth of this is for the procurement of drugs and medical equipment. The lion’s share goes for salaries and allowances, though the number of physicians and nurses is far below the demand.

Development expenditure is much higher than non-development expenditure in the transport and communications, energy and power or local government (for road construction) sectors. In the education sector, development costs are almost equal to operational costs. But like the agriculture and social welfare sectors, operational expenditure is higher than development expenditure in the health sector.

The Annual Development Programme part of the allocation was increased over the last decade. In the 2010-11 financial year, this was 42 per cent of the health budget. In the current fiscal this is over 47 per cent. The development part of the health budget had increased due to several projects to construct a number of medical colleges and hospitals over the past few years.

Additional secretary (budget) of the health services division, Rasheda Akhter, told Prothom Alo that tackling coronavirus will feature prominently in the next budget. But there will also be the regular allocation for the health sector. She said initiative was being taken to address the discrepancy between infrastructure and human resources. She gave the example of the recent appointment of a few thousand physicians and nurses. These appointments, however, were made in light of the coronavirus outbreak.

Member of the planning commission’s general economic division (GED), Shamsul Alam, speaking to Prothom Alo, said, coronavirus has exposed the fragile state of the country’s health sector. He said healthcare for the poor must be ensured.

Development and demand

There are 57 health sector projects in the current financial year’s ADP. Of these, 43 are of the health services division. The remaining projects are of the family welfare division. The total development allocation is Tk 122.66 billion, not even 6 per cent of the ADP.

Of the projects, 27 are for the construction of medical college and hospital buildings, where there is highest scope for corruption. There are a few projects for the health, population and nutrition programme. There is only one project for research, the topic being maternal health.

Professor of DU’s health economics institute Syed Abdul Hamid said there is no alternative but to increase allocation for the health sector. Skilled human resources must be created to prepare budgets for the health ministry and directorate. The government must pay special attention of the health sector. Coronavirus has pointed out that health is not the responsibility of the health ministry alone.

This report has been rewritten in English by Ayesha Kabir