In the development agenda, health has always remained a cross cutting issue. Without ensuring accessible and improved health facilities for its citizens, a nation cannot reach its desired development goals. This is why, all development organisations (government and non-government) at both national and international levels tend to keep 'health' as one of the many subjects of focus in their development policies and programmes.
As a constitutional obligation, Bangladesh has made considerable progress in the health sector over the last few years. However, this growth remains slower than required in order to achieve the ambitious goal of becoming a developing country by 2021.
The incumbent government has committed to ensure health facilities for all citizens through the formulation of various policies like 'Health Policy', 'Population Policy' and the 'Pharmaceutical Policy'. In order to properly implement the steps and strategies mentioned in these policies, proper budgetary allocation is needed.
The proposed national budget for fiscal year 2019-20 was announced on June 13, 2019. The allocation for health services division in the proposed budget for the next fiscal year is Tk. 199.45 billion (including operating budget of Tk. 100.08 billion and development budget of Tk 99.37 billion). This is 3.81 per cent of the total budget.
Though this proposed allocation is Tk. 17.79 billion greater than that of the allocation of previous fiscal year, as a percentage of the total budget it remains lower than that of the previous fiscal year.
Based on track record, the proposed public investment in health service sector has marked negative revision over the last few years.
Another vital weakness has been the irregular implementation of programmes related to health service. Over the last few fiscal years, it was seen that implementation rate was very poor in first eight or ten months of the years. Around the last two to three months, a huge amount of funds were released from the concerned authority, which did not help the health service sector efficiently. The hasty use of these funds often led to arguments about transparency. For example, during ongoing fiscal year of 2018-2019, the revised allocation for Annual Development Programme (ADP) is Tk 82.61 billion for this sector. From this, only 50.83 per cent was implemented from July till April of the year. Remaining 49.17 per cent needs to be implemented within the last two months of the year. Lower public investment along with poor implementation status cannot really help the health service sector in the ways required.
The last household income and expenditure survey (HIES) of the country revealed that the household expenditure has increased at an accelerating pace over income. As a result, people are struggling to maintain their livelihood. They tend to cut down on their food expenditure so that they can manage their other basic needs. Also, the income inequality has been on the rise over the last few years. As a result, the rich are becoming richer while the poor are plunging further into poverty. Under such circumstances, the budgetary allocation to the health service division this year is not favourable for the country's population of nearly 170 million.
At the moment, specific new steps, required to ensure health facilities for those who have less access to them, are still absent in the proposed budget for FY 2019-2020. More specifically, the government was not able to complete most of the initiatives taken during the proposed budget of the last fiscal year. In fact, based on the Budget Speech of FY 2019-20, it seems that most of the initiatives targeted during the last fiscal year but were left incomplete, are being taken up again this year.
The public health system in Bangladesh is still in shambles. The doctor-population, doctor-nurse, nurse-population ratios are far away from satisfactory levels. Additionally, inequality and soaring prices of essentials are making it difficult for people in lower and middle income groups to access health care services.
In health related services, adequate and available manpower is lower than the necessary. Furthermore, high rate of absenteeism undermines service delivery. Due to the comparatively lower compensation at public hospitals, many doctors and nurses are going to private clinics. Therefore, a patient finds it difficult to get adequate and proper health services from public hospitals.
Due to the weak monitoring and regulatory framework as well as lack of communication between central and root levels service providers, achievement of universal health coverage has been really difficult. Besides these, lack of accountability and transparency, corruption and mismanagement of allocated money is making the outlook gloomy.
Still some progresses have been made. Increase in life expectancy and reduction of other death rates have improved over the past few years. To sustain this improvement, the government needs to consider drastic steps aimed at improving this sector.
Theoretically, some of the strategic documents and policy papers are sound and seem implementable. But in reality, the outcomes are yet to be determined. Lack of appropriate strategies, country's institutional inability to effectively implement policies and programmes, the abysmal record of poor governance in terms of inefficiency and corruption and the lack of transparency and accountability are the major impediments standing in the way of achieving the desired targets in the health sector. Existing policies and programmes need to be reviewed and revised to improve accessibility, affordability and quality of services. The government needs to be creative in renewing and revising strategies and approaches.
The constitution of the People's Republic of Bangladesh has underlined health as one of the basic needs [Article 15(a)]. Unless the efforts become more focused and are accelerated, it will be very difficult to ensure health facilities for all. In order to to reach the targets of Sustainable Development Goals (SDGs) and to realise Vision 2021, the government should revise the allocation for health services in the proposed budget and increase the allocation and by renewing and revising all the policies and programmes related to this. Otherwise, the aim of ensuring health facilities for all will remain only in words.
KM Mustafizur Rahman is a teacher at the Department of Population Science in Jatiya Kabi Kazi Nazrul Islam University and Chairperson at Research Institute for Social Transformation (RIST), a policy research organisation in Rajshahi.
