Dr. Samir Kumar Saha :
Health is one of the important human rights and universally declared index of human development. Development of health not only promotes economic progress, but also ensures the quality of human life as well as social progress. So, it is the responsibility of the state to provide quality health services to all the people.
We have to give importance to attaining SDG-3 in the health sector. The SDG called for ensuring healthy life of all the people.
Though health is one of the basic rights of the people, universal health coverage is yet to be ensured in the country. A number of problems have been prevailing in the sector.
There are a number of problems regarding implementation of policy and attaining SDGs in the country’s health system. These are: inadequate budget, graft, reduction in amount of overseas assistance, lack of financial accountability and time-befitting development plan and implementation process, and non-availability of skilled human resources.
It also includes manpower crisis, regional disparity, scarcity of infrastructure and modern equipment. Unequal financial allocation led to regional disparity regarding health services distribution, which created obstacle to improvement of life of people.
Analyzing some previous budget regarding allocation in the health sector, it is seen that there was no increase in the budget. In 2009 fiscal year, allocation in health sector was 5.7% of our total budget, while it came down to 4.5% in 2015 fiscal year.
In Bangladesh, it is a matter of concern that allocation in health sector decreased compared to target in the 6th fifth year plan, which indicated inadequacy in the allocation.
In 2018-19 fiscal year, Tk 23,393 crore (5.03% of total allocation) has been allocated in the budget. According to suggestions of WHO, allocation in health sector should be 15% of total budget.
It is regrettable that the allocation in the budget’s health sector remained neglected in the past 12 years.
In Bangladesh, about 40 lakh people are going down poverty line every year due to health related expenditure. As per international standard, per head health expenditure (government, private and personal) remained lowest in Bangladesh.
Per head allocation in health sector in Bangladesh is 32 dollar, while it is 61 dollar in India, 39 dollar in Nepal, 111 dollar in Vietnam, 720 dollar in Maldives, and about 1000 dollar in Sri Lanka.
On the other hand, out of pocket expenditure in Bangladesh is 63.3%, which is very high. In India, it is 57.3% and 49.2% in Nepal.
Several issues such as tendency to earn profit in health sector by commercial institutions, taking increased fees from patients and lack of government monitoring complicated the existing problems in the sector. Such situation resulted in more sufferings for the patients.
Rights activists working in the sector think that whatever may be the budget, its expenditure process is very weak in the country. There is poor performance of its utilisation. Due to delay in releasing the budget money, a hurried tendency of misuse of funds is found at the end of fiscal year.
Our health sector is plagued with anomalies such as mismanagement, unskillness and misuse of funds. There are manpower crisis, lack of modern equipment and adequate allocation. There is discrimination regarding availability of quality health services outside Dhaka as there are vacancies of posts at government health institutions. Vacancies for post of physicians also remain at the Health Ministry.
As per the recommendations of World Health Organisation (WHO), there should be four nurses along with a physician, while doctor-nurse ratio is 1.2 in Bangladesh.
According to Bangladesh Health Facility Survey (2014), there is more vacant post of specialist doctors at district and Upazila levels. Similarly, there is scarcity of essential services and equipment for providing services to patients at Upazila Health Centre.
Unused equipment piled up at government hospitals alongside scarcity of equipment and materials.
According to an observation of World Bank, 42% medical equipment is kept in box. Scarcity of manpower and unplanned buying of medical equipment and corruption in the sector are blamed for the problem.
In our country, budget formulation process is completely centrally managed. There is no scope of taking local people’s expectations, needs and trend of disease into consideration while making the allocation.
Health budget for upazila is fixed as per the directive of Health Directorate. The Directorate or the concerned Ministry takes decision on expenditure. There is no scope of reflecting the needs of local people in the process.
Regarding Upazila level health budget structure, it is seen that 52% is allocated for salary of officers-employees, 37% for allowance and 11% for supply and service sector. Food supply is the main sector of expenditure here. Hence, there is limited scope of locally solving any problem if trouble ensues in any matter.
The rights activists, working at the health sector, demanded adequate allocation in health budget taking the matter of public health into consideration. Along with increased budget, they also demanded removing bureaucratic complexity regarding the release of allocated money.
They called for ensuring adequate allocation in the health sector by equally giving importance to curative and preventive issues.
To overcome crisis in our health sector, we can utilise the manpower from alternative system such as Unani, Ayurveda and Homeopathy. We can use the system, which is approved by WHO, also to provide health services to the people.
Many countries in the World got benefits through using the system, which can easily be available because of its comparatively lower price. In view of the above-mentioned problem, the government can consider the issue.
It is hoped that the authorities would come up with specific decision on the issue along with increased financial allocation for the health sector. Otherwise, the people will continue to suffer hampering the country’s development.
(Dr. Samir Kumar Saha, Vice Chairperson, Public Health Foundation, Bangladesh)
