Health sector needs serious overhaul; crisis acknowledgement is but a first step
Each year, within 24 hours of the finance minister's placing the national budget proposal on the floor of the Parliament, the Finance Division arranges a brief for the press that provides the government an opportunity to defend its planned budgetary measures and respond to any criticisms.
In this post-budget discussion, very rarely do we hear too much of interest.
This year, however, our Finance Division's Senior Secretary Abdur Rouf Talukder needs to be applauded for breaking new ground.
He was very clear, univocal, and candid in acknowledging the following facts:
- Bangladesh’s public health procurements are all supply-driven and not driven by the needs of the people
- Project directors in the health sector lack experience in project management
Why these acknowledgements are so important
Not that the average Bangladeshi does not know the above facts, but an official acknowledgement should be cheered as a first step towards mending the problems.
It is by now public knowledge that the Health Ministry and offices under its command have miserably failed to make the best use of the annual development funds made available to it in FY2020-21.
The finance minister's proposed increase in the health's budgetary allocation for FY2021-22 dismayed many who expected a much higher rise in health budget during pandemic time.
But in fact the bigger dilemma remains the Health Ministry's poor capacity to properly utilize even the paltry funds that are allocated to it.
The resultant reality is that Bangladesh’s 170 million people are being made to bear one of the highest out-of-pocket (OOP) expenditures for healthcare anywhere in the world.
As per the World Bank’s latest available data, Bangladeshis' per capita OOP health expenditure ($74) is only second to war-torn Afghanistan ($78) in South Asia.
People in India ($63), Pakistan ($56), Nepal and Sri Lanka (both $51), Maldives ($21), and Bhutan ($ 13) all bear a lesser burden as their public health sectors take better care of their citizens' health.
GDP growth doesn’t reflect the true picture and vulnerability of public health financing in Bangladesh. Bangladesh can well boast of its per capita income growth overtaking India and Pakistan -- but the country's share of public health financing is still below theirs.
Bangladesh's health budget is still just one percent of GDP and around five percent of its total budget, whereas, WHO has recommended that it should be five percent and 15 percent respectively.
At the post-budget press briefing, the finance secretary was not wrong to point out that there was no problem with the allocation in the health sector, as a portion of it remained unspent in the current fiscal year.
He added that the full amount could not be spent because of problems in the procurement process and the inexperience of the project directors.
As a top bureaucrat it was perhaps not possible for him to mention what we all know, which is that graft and irregularities are equally a problem. In fact, these are the primary problems.
If Bangladesh really wants to offload some OOP burden from its citizens, it has to not only spend more on health, but also to significantly curb graft and enhance its capacity to use resources properly for the benefit of the public.
In the finance secretary’s words: We have to make health sector procurements demand-driven rather than supply-driven.
We all can understand that "supply-driven" is nothing more than a euphemism for corruption.