Expenditure of bulk allocation for health sector must be specified

Before the budget was announced, I had said I wanted to know its literature. But that literature remains unknown. By literature I mean an analysis of the overall feel of the budget. But where is that analysis?

The budget should have pinpointed the weaknesses in the health sector, but I do not see any such evaluation. It does not indicate the places where we are stuck, though it is clear that we are indeed stuck. All that the budget has done is acknowledge the advent of coronavirus. Health is not just a sector, it is a strategic matter, but this understanding was not reflected in the budget speech. This was very much needed. The budget speech merely stated that COVID-19 has hit us hard. That’s it.

Health services have been extensively damaged and this damage will continue. We do not know what lies ahead. There is no probe into this, no analysis, no attention towards analysis. There is a lack of attention and a lack of efficiency. The media often uses the term ‘routine report’, this is how the budget appears.

There was only one line that made mention of the weaknesses in the health sector, though this issue should have been strongly highlighted. After all, allocation and the proper use of the allocation depend on radical reforms in the health sector.

The reforms are required for several reasons. The inefficiency, corruption and pilferage in the sector are no secret. The health ministry is caught up in projects, in meetings and committees, but all on paper. This has become all the more obvious during this time of COVID-19.

Now that the bulk allocation has been made, it is vital to specify the expenditure. This must be done within the next two weeks. After all, there is ample scope for corruption and pilferage in bulk allocations.

The proposed budget speaks of a Tk 10 billion (Tk 1000 crore) allocation for research. That is a good step, but with the prevailing lack of trust, the question remains as to how the research will be conducted. Research is given little importance in the health policy and in the running of the health directorate. It is basically the bureaucratic who rule and so questions remains about how the allocation will be utilised. Dr Zafrullah came up with a testing kit by means of local research. The attitude displayed towards this achievement gives rise to apprehensions about how the overall attitude will be towards local research. How much attention will actually be paid to proper and effective research, remains questionable.

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There is glaring discrimination in the health sector. During these times of coronavirus, the very wealthy and those close to the powerful quarters, have the opportunity to go to the best establishments. And there are hardly more than a couple of such establishments. The virus transmission and the death rate continue on an upward curve.

Coming to the matter of allocation, previously it was around Tk 250 billion (Tk 25,000 crore). This time is its Tk 290 billion (Tk 29,000 crore). But around Tk 35 billion (Tk 3,500 crore) of this is coming from World Bank and Asian Development Bank (ADB) projects. Without the costs of these two projects, the allocation stands at Tk 10.22 billion (Tk 1,022 crore). The picture is clear.

A bulk allocation of Tk 100 billion (Tk 10,000 crore) has been made this time for coronavirus. Bulk allocations are generally made for emergency purposes or for unknown issues or for possible requirements. Does the government still not understand what is to be done or what is not to be done?

Now that the bulk allocation has been made, it is vital to specify the expenditure. This must be done within the next two weeks. After all, there is ample scope for corruption and pilferage in bulk allocations. Even if not the entire amount, sector-wise expenditure of at least Tk 70 billion (Tk 7,000 crore) to Tk 80 billion (Tk 8,000 crore ) must be specified. We can even point out certain specific sectors.

The bulk allocation can be used in areas where the infection is higher, such as Dhaka, Narayanganj, Gazipur and Sylhet. Private hospitals can be requisitioned, if necessary. Many institutions within the circle of power have already taken over hospitals for themselves. The government must now increase these facilities to all.

There are upazila health complexes in all upazilas, but no hospitals in the sadar upazilas (upazila headquarters). A crash programme can be immediately taken up to establish one upazila health complex in each of the 64 sadar upazilas. This is a specific area to utilise the Tk 100 billion (Tk 10,000 crore) allocation.

The health of women and girls has been overlooked in these coronavirus times. Based on primary data, there are apprehensions of an increase in unwanted pregnancies and unsafe deliveries. Violence against women has also increased. At this time, it is important for the budget to have specific psychosocial assistance for women and girls

Primary health in the urban areas is another possible area for allocation. This service must be given particularly in slum areas and areas populated by persons of the lower income bracket. Ward-based health substructure is needed in Dhaka, Narayanganj, Sylhet and Khulna.

There is so much talk about hand washing. This requires water. Large investment can be made now in public washrooms and hand washing facilities. This can be carried out on a priority basis community-wise, particularly in low income areas.

There is a Tk 6 billion (Tk 600 crore) proposal regarding hygiene in 329 pourashavas on the country. It will not harm to allocate them Tk 10 billion (Tk 1,000 crore).

Awareness programmes regarding hygiene is an important matter. In the eighties and the nineties there were extensive awareness programmes for birth control, primary education, women’s education, immunisation and sanitation. Bangladesh achieved a lot through these awareness programmes. This awareness mobilisation was done by including the NGOs and social forces. The government had an immunisation programme for long but it hadn’t been effective. It picked up speed once the NGOs were involved.

Extensive social awareness mobilisation is required for hygiene. When this issue arises, it is said, okay, go ahead. But this requires funds, a budget. It won’t happen automatically. Hygiene should be a top agenda on the priority list. NGOs, social forces and the youth must be included in these programmes.

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The finance minister’s budget mentions the maternal mortality rate at 169, but this is a debatable figure. Another division of the government puts this figure at 196.

The health of women and girls has been overlooked in these coronavirus times. Based on primary data, there are apprehensions of an increase in unwanted pregnancies and unsafe deliveries. Violence against women has also increased. At this time, it is important for the budget to have specific psychosocial assistance for women and girls.

* Hossain Zillur Rahman is the executive chairman, Power and Participation Research Centre (PPRC)