Budget for Health Ministry: No big rise for inefficiency
The health ministry will not see a significant rise in allocation in the upcoming budget amid Covid-19 pandemic mainly due to its lack of capacity to utilise funds, say planning ministry officials.
The ministry has failed to complete one-third of the development projects under the Annual Development Programme (ADP) within the deadline, meaning those have to be approved afresh. Besides, many of the projects will require additional funds, they point out.
There have been expectations that the size of allocation and the number of projects in the health sector will go up significantly in the next fiscal year, as the country is facing an unprecedented challenge from coronavirus pandemic that has exposed the vulnerabilities of the healthcare system.
With Covid-19 infections on the rise, a lack of Intensive Care Unit (ICU) beds and a shortage of oxygen in most of the hospitals have become a matter of concern.
The government recently took two coronavirus-related projects involving Tk 2,492 crore funded by the World Bank and the Asian Development Bank. The projects, approved by the Ecnec last week, have been included in the ADP for the next fiscal year.
Against this backdrop, Finance Minister AHM Mustafa Kamal is likely to allocate Tk 27,600 crore for the health ministry in the upcoming budget to be unveiled in parliament on June 11, said officials of finance and planning ministries.
This means the allocation for the ministry will increase by 7.25 percent from outgoing fiscal year's allocation of Tk 25,733 crore.
The allocation includes the health ministry's ADP budget of Tk 13,033 crore, which is 6.25 percent higher than that in the outgoing fiscal year.
According to the World Bank's World Development Indicator 2019, Bangladesh has the lowest per capita public expenditure in the health sector among the South Asian countries. In India, per capita expenditure was $15, while it was $14 in Pakistan and $6 in Bangladesh. The average South Asian per capita public expenditure was $15.
Talking to The Daily Star, Shamsul Alam, senior secretary at the General Economics Division of the Planning Commission, said, "You cannot say the ADP allocation for the health ministry is low… Around 5 percent of the total ADP has been allocated for the ministry… There are 58 ministries and divisions.
"Implementation is more important than allocation. We do not see 100 percent utilisation of the allocated money. There is no dearth of funds… But they [the health ministry] need to increase the capacity for utilising funds and ensuring accountability to improve service."
At least 22 out of 62 projects under the health ministry could not be implemented within the deadline, according to officials of planning and finance ministries.
They also mentioned that the pace of implementation of the ministry's largest project -- Tk 36,000-crore Fourth Health, Population and Nutrition Sector Development Programme -- has been slow with the ministry failing to spend two-third of the money allocated since June 2017.
The project officials need to utilise the funds by June 2022 if they are to complete the project on time, they added.
According to the planning ministry's Implementation Monitoring and Evaluation Division, till April this year, around 70 percent of the health ministry's projects under the ADP were yet to be implemented.
Talking to this newspaper, economist Hossain Zillur Rahman, executive chairman at the Power and Participation Research Centre, said, "The health ministry is a consistent poor performer in terms of ADP implementation. There are some issues like a lack of capacity and corruption.
"So it is understandable that the finance ministry is in doubt about increasing the health budget."
In the absence of adequate allocation and proper utilisation of funds, the out of pocket expenditure (OOP) of people is very high in Bangladesh, mentioned Zillur.
A 2015 health ministry survey shows the OOP accounts for 67 percent of the total healthcare expenditure in Bangladesh. This means, if the healthcare cost is Tk 100, the government provides Tk 34 while the patient spends Tk 67.
The OOP in Bangladesh is the highest in South and Southeast Asia.
Professor Syed Abdul Hamid of the Institute of Health Economics at Dhaka University said, "Implementation of ADP is a problem for the health ministry. A lengthy process of preparing proposals for development projects, feasibility tests and tender are some of the key reasons for the delay in project implementation."
"We also cannot rule out the scope for corruption," he added.