Health Sector Faces Difficulties Due to Inadequate Allocation

Weakness inside the country's Health sector seems to be exacerbated during coronavirus outbreaks. Although the outbreak is not in large scale, the biggest shortage of healthcare is revealed in this sector. Medical services are a long way off as the country's health sector is struggling to identify patients.

The health sector has been neglected in the national development and expenditure structure since independence. Again, there is no proper implementation of the meager allocation. Due to irregularities and corruption, even a small amount of money allotted is being wasted. Again, even if one or two projects are undertaken for the development of the health sector, they are not implemented in the end due to lack of expertise. Due to these reasons, people are suffering in getting treatment.

The private sector has expanded due to the crisis in health services in the country. However, the right treatment is not available even after spending heavily in the private sector. Those concerned say the coronavirus has shown where the weakness of the medical system is. Therefore, it is necessary to allocate a large portion of the budget for the new fiscal year to overcome the crisis in the medical and health sectors.

The medical system of the country is mainly Dhaka-centric. Outside the capital, Dhaka, the treatment system is a bit better in one or two big cities, but in the district cities, it is not up to the mark. The main reason for this is that the health sector has not been given importance since independence. Although there is some allocation in the national budget every year, corruption is rampant due to lack of monitoring of its expenditure. As a result, there has been no improvement in the health sector in terms of expenditure. On the contrary, the crisis has intensified.

The national budget for the last fiscal year was presented and passed amidst the outbreak of coronavirus. Even then, in the budget for the fiscal year 2020-21, 5.2 percent of the total budget, i.e. Tk 29,247 crore, was allocated to the health sector. Which is only 3 thousand crore more than the previous fiscal year. In the last 2019-20 fiscal year, the allocation for health and family welfare was Tk 25,732 crore. And in the 2018-19 financial year, the amount of this allocation was 22 thousand 336 crore. The health sector is getting less than 1 percent of GDP. Among developed countries, New Zealand spends 9 percent of GDP in the health sector. According to a 2018 report by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP), Bangladesh has the lowest health allocation among the 52 countries in Asia and the Pacific in terms of GDP.

Coronavirus infection has been ongoing since last year's March. The second wave took on a more deadly shape. The process has started in the budget of the new fiscal year 2021-22. It will be presented in the National Assembly on Thursday (June 3).

Regarding this budget, CPD's Professor Mustafizur Rahman said, "Right now we need to strengthen the health sector and social security sector." Our allocation in this sector is less than that of South Asian countries. The country has now created a huge opportunity in this sector through community clinics. The government can think of ways to improve people's health care by coordinating with clinics.

According to the source, people are being infected and dying from coronavirus infection but the budget allocation and expenditure are going on at a snail's pace. The budget for the first 10 months of this year (July-April) has been implemented at 42 percent. At the same time, the 10-month implementation of the Annual Development Program (ADP) is only 49 percent. Of these, only 31 percent have been able to spend the most needed allocations in the health sector. However, in the current financial year, more allocation was given to the health sector to address the ongoing Covid-19 challenge. Due to corruption, irregularities and mismanagement in the health sector, the allocation for the health sector is not going to be spent in the current financial year.

Rashid-e-Mahbub, former president of the Bangladesh Medical Association (BMA) and convener of the National Health Rights Movement, said the budget is not at all sufficient for the traditional treatment of the country's people. It is not possible to expect proper treatment without streamlining the medical system. After paying the required number of doctors, nurses and technicians on a limited budget, it is not possible to meet other needs including medicines.

Fahmida Khatun, executive director of the Center for Policy Dialogue, said the budget was inadequate for Bangladesh's 170 million people. In last year's budget, the per capita allocation was only Tk 1,537. For this reason, people have to spend about 66 percent from their own pockets. In other words, if Tk 100 is spent on health, the government assistance is Tk 34 and the remaining Tk 66 is borne by the patient himself. Spending this money becomes a big problem for many people.

According to the government's health department, there are 654 government hospitals in Bangladesh and the total number of beds in these hospitals is 51,316. And there are 5,055 private hospitals, where the total number of beds is 90,587.

On the other hand, the analysis of the expenditure in the health sector has shown that on the one hand, the budget allocation is less, on the other hand, this allocation is spent on physical infrastructure, training and salaries and allowances rather than medical expenses. Out of the total allocation of Tk 25,733 crore this year, Tk 13,466 crore has gone to the management sector. Only about a quarter of this is allocated for the purchase of medicines and equipment. The rest of the money is going to the salary-allowance. Although the number of doctors and nurses is still much less than needed.

Speaking to concerned, the infrastructure is known to have some; but there is no work. The patient's stress is much higher; but there is no standard treatment for them. The allocation for patients in hospitals is also very low. Again, most of the allocation is embezzled. The concerned officials of the Ministry of Health, Department of Health and hospitals are involved in corruption. They are pocketing the allotted money by showing unnecessary expenses. The health sector has been named among the top corrupt sectors in the Transparency International Bangladesh Corruption Perceptions Survey many times. Corruption in the TIT services sector: According to the National Khana Survey 2017 report, the health sector is one of the most corrupt sectors, with a corruption rate of 42.5 percent.

On January 31, 2013, the Anti-Corruption Commission (ACC) submitted a report to the Health Minister of Bangladesh, Zahid Malek, identifying 11 areas of corruption, including procurement and recruitment in the health sector. There are 11 sectors identified in the health sector including spending, medical services, use of medical equipment, supply of medicines; But no action was taken in the health sector on the basis of that report.

Iftekharuzzaman, executive director of TIB, said it was becoming increasingly clear that the health sector was in a fragile state due to long-standing corruption, mismanagement and the lowest allocation to GDP. Corruption in the procurement of the health sector, for those reasons, the quality of services in the health sector has always been neglected. Those involved in various irregularities and corruption remain out of reach for two reasons. Involved with influential quarters, as well as a section of administration bureaucrats or officers-employees.

He added that the government has no choice but to overhaul the health sector. Therefore, the allocation in the New Fiscal Year's budget should be increased; but in order to do that, in order to get rid of irregularities and corruption, it is necessary to bring transparency in this health sector.