In the proposed budget for the fiscal year 2022-2023, the allocation for the health sector has increased by Tk 4,132 crore. This rate of budget growth in the health sector is low considering the increase in overall expenditure. At the same time, however, questions have been raised about the ability of this sector to spend and utilise the budgetary allocation appropriately. Although the Covid pandemic has exposed the crisis of health management in the country, the Health Ministry does not have a specific roadmap to streamline the health sector in the budget allocation for the next financial year. The ministry has been able to spend only 41 per cent of the allocation given to the health sector last year. The remaining 59 percent remained unutilised. Year after year, the budget of the country’s health sector is being prepared in an orthodox way. The allocation is much lower than required. Even after that, the health sector can’t spend the allotted amount wisely. There is no action taken or plan made by the sector to change the situation. In the country, this sector is going on with stagnant philosophy.
This year’s budget: Proper implementation a far cry
On June 9, Finance Minister AHM Mustafa Kamal presented the budget for the fiscal year 2022-23 in the National Parliament. Reviewing the budget, it has been seen that in the proposed budget of Tk 6,78,064 crore for the fiscal year 2022-23, the allocation for the health sector is Tk 36, 863 crore. In the fiscal year 2021-22, the allocation for this sector was Tk 32,731 crore. As such, the allocation for this sector has increased by Tk 4,132 crore, which is 12.62 percent more than the previous year.
From the budget of the current fiscal year, the size of the proposed budget for the next year has increased by 12.62 percent. However, experts believe that this year should have more budget in the health sector. They say that it is necessary to focus on increasing the allocation in this sector without worrying about the amount of allocation. Because after the coronavirus infection was detected in the country, the mismanagement and adversity of the health sector was exposed and a lot of lives were lost. There was a lot of discussion about increasing the allocation in the health sector afterwards. But the irony is that the Ministry of Health has not been able to spend most of the amount allocated for this sector in the last two financial years due to lack of skills and planning.
Experts say that the inability to spend budget allocations due to lack of skills and planning should be seen as a failure of the health ministry. If we cannot increase the spending capacity through proper planning, increasing the budget allocation will not be of much benefit. Public health experts also say that it is important to take multi-pronged plans as soon as possible to increase the spending capacity of the allocated budget and make the manpower efficient.
The rate of allocation in the health sector in the last five years
Reviewing the allocations for the fiscal year 2017-18 to 2022-23 in the country, it is seen that the allocation rate in the health sector as a part of the total budget is below 6 percent. Considering the current health situation of the country and medical expenses, the parameter set by the World Health Organisation, public health experts say that 15 percent of the national budget should be allocated for the health sector. However, in the proposed budget for the fiscal year 2022-23, it is seen that the allocation rate is still below six percent.
Concerned parties say that the growth rate of the health sector is low considering the increase in expenditure in the proposed budget this year. However, due to the lack of a specific plan in this sector, there is an inclination to not be able to spend the budget even if it is lower than expected; thus, there is no benefit in increasing it. The ministry has been able to spend only 41 percent of the budget allocated for the health sector in the fiscal year 2021-22. In other words, about 59 percent is likely to return this time. The country’s health sector is unable to move forward mainly due to the failure of the Ministry of Health to have a specific plan and skilled manpower.
What experts say?
Experts say that the budget for 2022-23 has been proposed keeping in view the continuity of the previous fiscal years. As a result, it may be possible to meet some short-term and immediate needs of the health sector. However, it will not bring a solution in the long run. It has been seen in this fiscal year that the allocation in this sector has been increased in the budget compared to the previous financial year. This has been done before. As the picture of the health sector of the country that has emerged in the last two years, the highest importance should have been given in this particular sector. However, like other years, the health sector budget is nothing more than a change in arithmetic numbers.
Dr Atiur Rahman, former Governor of Bangladesh Bank, said, “The health ministry cannot spend half of its development budget. Thus, the government has adopted a policy of reducing the expenditure. But, it is essential to increase spending capacity in the health sector instead of reducing expenditure.” He also suggested reducing the focus on expensive equipment purchase and increasing, utilising the cost for manpower and primary health care.
Former President of Bangladesh Medical Association Prof Rashid-E-Mahbub said, “Apart from increasing the capacity of the country’s health sector, irregularities and corruption must be stopped. Without this, it is not possible to ensure proper health care for the people of the country.” “At the same time change in policy and method must be brought. Health directorate have to think about long term planning. Otherwise, it will be seen that even if the allocation in the health sector is increased, it will not be possible to achieve the desired target,” he added.
“We must demand more allocations,” he said adding that it is necessary to improve the health system of the country. But it’s seen that the ministry is not able to spend at the rate at which the budget is being allocated in each financial year. Why not? – To find the answer, the Ministry of Health needs to increase its ability to spend budget with planning. Otherwise, whatever the budget, it may not be of any use to the country.
Syed Abdul Hamid, professor at the Institute of Health Economics, Dhaka University, said, “There is nothing new in the proposed budget for 2022-23. Although some project expansion issues are in the proposal, there is no surprise in it. The arithmetic increase is likely to offset rising costs and inflation. ” “It was seen that allocation is increasing in many sectors but there is no spending capacity and efficiency. One of the reasons why the budget remains unused is the lack of capacity and efficiency. And so, the government has to think about the budget with these considerations,” he added.
In response to a question whether the country learnt from the Covid pandemic situation, he said, “What we realised during the pandemic was that the preventive care of our health service had been totally ignored. Preventive care means that we need to educate people about health safety, which is a continuous process. We need to educate them about the importance of safe air, safe food, safe water, and a safe environment. But we don’t seem to have any plan at work to improve our preventive care. We have told this time and again during the pandemic, but nothing has changed. For example, we have an office for preventive care at the upazila level, but there is not enough manpower to run those offices. This needs to change.”
Analysis of the last 10-15 years’ data shows that although 95 percent to 98 percent of the operating budget is spent every year, over 25 percent of the development segment remains unused. The development budget is not used rationally for various reasons, including a lack of efficiency in procurement, bureaucratic complexities, and delayed release of funds. A proper reformation is vital and health ministry must come up with a proper road map to address and solve the issue. They need to form a strong task force for the development of the health sector. The task force will identify and resolve the issues prevailing in the sector.
The pandemic is likely to end soon, but many more epidemics may come in the days ahead, and put us in danger. If the healthcare sector in the country does not improve, the tendency of people to go abroad for treatment will increase and the pressure on the dollar will increase.
The health ministry must prioritise realising the budgetary allocation more efficiently this time. Finance Minister has mentioned a few priority areas for government expenditure in the health sector in his speech. Keeping in mind the next wave of Covid and many other infectious outbreaks that may hit us in the future, Bangladesh needs to prepare effectively. Although the budget mentions vaccinating 80 percent of the population, it does not declare a specific allocation for the purpose. A subsidy allocation of Tk 100 billion has been kept in the budget to manage emergencies like the Covid pandemic. But appropriate use of this remains a challenge to health ministry. It has been more than one year since the pandemic struck us, but our effort towards increasing the number of hospital beds and oxygen in public hospitals has been very little. Despite a large proportion of the health budget each year is spent on physical infrastructure development, still the countrymen have suffered throughout the pandemic due to the unavailability of resources. Proper utilisation of the budget for infrastructure development must be a priority this time, otherwise a large portion of the budget will remain unutilised this year.
Mass awareness campaigns were crucial in tackling the Covid outbreak. Covid post period may cause higher mental illness among public as many lost their relatives, some lost their jobs. Despite 17 percent of adults suffering from mental health issues in the country, our public spending for mental health services is only around 0.05 percent of the total health budget. This sector should be given importance and the budgetary allocation should be utilised properly in this sector.
A large part of the development budget is spent on procurement. Those who are involved in spending money in this area lack procurement-related skills. Generally, physicians are less interested in accounting, economics, and finance. Even though doctors who are assigned to perform these tasks are now given some relevant training, but it is very few. Besides, any procurement requires permission from various authorities at various stages. Therefore, power needs to be decentralised to ease budget implementation.
Purchases can be made on time if funds are disbursed at the beginning of the fiscal year. It is necessary to build a central entity to conduct all procurement activities. Post-purchase corruption related to audits and accounts should be stopped. Files should be digitised and file disposal time should be fixed at 3-5 days. Officers should be provided with sufficient training in economics, finance, and accounting. And for long-term health managers, separate positions need to be created in the Bangladesh Civil Service. Those who will be appointed to managerial positions in the health sector should do those jobs from the beginning.
A survey jointly conducted by the Directorate General of Drug Administration (DGDA) and the WHO shows that antibiotics consumption in Bangladesh has increased by 30.81 percent in the last two years as more people are buying antibiotics from pharmacies without any prescriptions. This puts their health condition at great risk as the unnecessary usage of antibiotics makes people antimicrobial resistant. The health ministry should use its budgetary resources to create mass awareness regarding the proper usage of antibiotics.
To wrap up, the current and past health budget allocations in the country are the lowest among South Asian countries except Afghanistan. Another bad aspect of the budgetary allocation is that the budget given to the health sector has failed to be spent by the concerned ministry. This deprives the people of the benefits they are supposed to get in the health sector. In addition, the allocation that is given is wasted and corruption is dominantly present in the sector. If these are stopped, the general populace will benefit from the most important sector.