• Monday, Jun 27, 2022
  • Last Update : 04:24 pm

Experts on health budget: No hope for long term development

  • Published at 12:59 pm June 13th, 2020
Coronavirus Doctor
File photo: A doctor gives treatment to a patient Syed Zakir Hossain/Dhaka Tribune

Corruption remains a big concern

Although the government has given the highest priority to the health sector in the upcoming National Budget for the Fiscal Year 2020-21 with additional allocation, incentives, compensations, health experts termed it as a short sighted budget that would not be beneficial for long term health sector development. 

Confessing the exposure of several weaknesses in the health sector during battling Covid-19 in the country, the Finance Minister AHM Mustafa Kamal said the exposure has prompted the government to formulate plans to sustain its long-term achievements as well as prevent and combat any kind of outbreak in future. 

But the experts and professionals observed it as a traditional one similar to last year’s budget and will have lesser impact on improving the non-Covid health care system. As a result the out of pocket expenditure would be increased. 

Director of Institute of Health Economics Professor Dr Syed Abdul Hamid said the health budget has three parts. One is the budget for the ministry (Tk 29,247 crore), bulk budget for fighting against Covid-19 (Tk10,000 crore) and budget for health related activities in other ministries. 

While analyzing the budget the professor said among them the other ministries’ budget would not be considered in the health budget as it would also pose the threat of duplications and other shortcomings while implementing. 

“The bulk budget would be rebuffed in no time soon after the Covid-19 emergency ended, so that would also not be included in the actual budget. So, the actual budget for the health sector is Tk29,247 crore,” he said. 

“Now among the 29,247 crore there are two projects (under ADB and WB) that would account for around Tk2,500 crore, which means the budget stands for some Tk26,700 crore,” the professor continued. 

Dr Hamid said the proposed budget for the health sector was Tk 25,733 crore. It means the budget has  increased only by Tk1000 crore. That can be useless as it could be spent for the ongoing inflation, increments of the employees and officials, the bonus, pensions and other trivial issues. 

“So, the budget for this year actually remained the same as the previous year,” the professor observed. 

He said: “As the lackings in the health management system came up during the pandemic battle, we were hoping for initiative to change in some specific sectors like CDC and others. But the budget has no such things.”

Secretary General of Bangladesh Medical Association (BMA) Dr Ehteshamul Huq Choudhury said “This is a short sighted budget and would be very useful for combating the pandemic. But the budget did not have any new plans to reform the health sector for sustainability.”

Tk10,000 bulk budget for Covid-19, fear of corruption still remains at large

According to the BMA secretary general the best part of the budget is the Tk10,000 crore Covid-19 allocation, Tk100 crore budget for medical research, and lowering import taxes for ventilators and ICU equipment. 

Ehteshamul said amid all of the good things, implementations would be the key factor.

“In previous years, we have observed that the top officials failed to use the fund sanctioned for them and they have to return a huge amount of the sanctioned money. This year the health officials needed to be more efficient to use the money,” he said

Bangladesh Doctors' Foundation (BDF) Chairman Dr Md Shahed Rafi Pavel said it is not clear if it seeks budget information from the clinician operating at field level. So there is doubt over effective use of the budget. 

“In previous years the health directorate and the Health Ministry never published details of the expenditure of the money. So, there is a chance of corruption as well,” he said.

Health economist Syed Abdul Hamid said when the country does not have that much revenue which means very few earning sources, “allocating Tk10,000 crore is a bold decision. The advantage of the bulk budget is that it can be spent avoiding Bureaucratic complexity, making timely use. But it has a demerit as well. It offers chances for corruption also.

“And our previous experiences suggest that hoping for no corruption in the procedure would be a dream only. But we want less corruption and efficient utilization of the bulk budget,” he added. 

Prof Dr Rashid-E-Mahbub, former president of BMA, said: “The law enforcers have hospitals for its personnel.  VIPs also have hospitals. But the frontline warriors  - the doctors who are dying while treating thousands of Covid-19 infected people do not have any exclusive treatment facility.”

According to BMA some 3,162 health care professionals, including some 1,002 physicians, over 800 nurses and some 1,360 other healthcare professionals have been infected till from Covd-19. 

Out of pocket expenditure to be increased

Bangladesh's healthcare system has already been struggling with the increasing burden of diseases, low quality healthcare coverage, and an inadequate national budget in this regard.

Rashid, also the Bangladesh Health Rights Movement chairman, said the status of lower middle income and poorer people will go down as an impact of the pandemic. 

“So the people will tend to rush to the government hospitals more and more,” he added. 

Among the sanctioned amount for the services, the Health Service Division of the ministry will get Tk4,518.04 crore, around 15% of the allocated money.

“It means, the government will spend less  thanTk1 if you count the population as 16 crore,” the former BMA president further said. 

Health economist Hamid said: “Almost 70% of the health out of pocket expenditures is borne by the people. Among the expenditure some 70% are needed for buying drugs, 20% for diagnostics, 7% for obtaining health care services at hospitals and 3% as doctors’ fees.

“It is very oblivious that the expenditure situation would never be changed as the budget has not changed at all. Rather it would be worse as the condition of the poor people would further deteriorate,” the professor added. 

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