The Ministry of Health did not implement need-based resource allocation mechanism in one year to ensure equity and efficiency, although it was suggested in the 4th Health, Population and Nutrition Sector Programme (HPNSP).
The same mechanism was proposed in the 3rd HPNSP (2011-2016).
The Executive Committee of National Economic Council (ECNEC) approved the 4th HPNSP on March 21, 2017 with the financial outlay of Tk 1,155 billion for the period of 2017-2022.
This is for the first time that the government's investment is around 84 per cent in the programme, while the development partners' contribution is only Tk 188.47 billion.
This size of the present HPNSP is higher by almost 126 per cent than the 3rd HPNSP, where the outlay was Tk 510.84 billion.
Public health experts criticized the present allocation process as inefficient, inequitable, and centralized. It is based on number of bed and staff in post for salary and in-patient only.
It was found in a public expenditure review of 2005-2006, prepared by Health Economics Unit and published in 2007 (HEU), that a patient of the most impoverished area gets Tk 100 per day for meal.
A patient of a moderately poor area gets Tk 300 per day, and a patient of the well off area gets Tk 200 per day. Only Tk 125 is allocated for one patient's meal per day in the present system.
One 50-bed upazila-level hospital gets Tk 65,200 per bed each year for medical and surgical requisite (MSR) or drugs and a district-level hospital gets Tk 154,500 per bed each year. A union-level hospital gets Tk 255,000 each year for MSR.
On the other hand, needs-based approach focuses on the health needs of a specific population, the relative costs of different services, the relative costs associated with different areas or with non-service delivery and use by patients in one area of services in another (cross-boundary flows).
Dr M A Sabur, a public health expert, told the FE that the 4th HPNSP was effective from January 2017. The need-based approach for resource allocation for the health sector was proposed in the 3rd HPNSP too, which exists in theory only.
"The Ministry of Health is not an isolated one. The budget allocation by the Ministry of Finance does not follow need-based approach."
The concurrence of the Ministry of Finance is necessary for implementing the need-based resource allocation from revenue budget, he also said.
Mr Sabur noted that the government's contribution is 84 per cent in implementing the 4th HPNSP, which means the donors' share in it has been reducing gradually.
It is happening, as the government has been publicizing that the country will become a middle-income one.
"On one hand, out-of-pocket (OOP) expenditure is one of the highest and it is increasing day by day. Besides, the government's allocation in the health sector is declining gradually, and the donors are restricting their fund flow for Bangladesh, indicating a gloomy picture," he added.
Professor Rumana Huque of Dhaka University Economics Department said the main problem is that there is no allocation for the outdoor patients. They are served with the same drugs, given for in-patient beds, which has been causing various drug resistances.
"HEU has advanced a lot in the need-based resource allocation approach. Even HEU has prepared a formula for this. The authorities concerned of the Ministry of Health should take necessary steps to implement it," she suggested.
