Health budget does not address affordable, quality healthcare
Dr Rashid-E-Mahbub, chairman of National Health Rights Movement Committee, talks to Naznin Tithi of The Daily Star about the policy initiatives that need to be taken to provide the public with affordable and quality healthcare and how the proposed budget has failed to address these issues.
The health budget for the next fiscal year is much lower than the World Health Organization's recommended level of 15 percent of the total budget. Only five percent of the proposed budget has been allocated for the health sector. What are your thoughts on this?
For the last 10 years, the budgetary allocation for health has been constantly around five percent of the total budget. If at least 3 percent of the GDP could be spent on health, it could have a major impact. Generally, the government provides allocation to public hospitals based on the number of beds. The amount allocated for each bed is very small. But as the number of people seeking treatment is much higher than the number of beds available, these extra people do not get any portion of the budgetary allocation.
Needless to say, the healthcare services in Bangladesh are not affordable to the general people and the quality of healthcare is also questionable. The government's view regarding the health sector is also not clear. Is the government trying to shift its responsibility by privatising the sector? But if the government wants the private sector to take responsibility for the health sector, it needs to ensure that there is a regulatory mechanism in place, which is not there at present.
Then comes the question of proper utilisation of budget. As we know, a big portion of the budget is used for infrastructure development and purchase of equipment. When it comes to buying equipment, it needs to be ensured that the equipment bought with huge funds actually benefits the users. There are many instances of abuse. For example, there are many healthcare facilities where electricity supply has not been ensured but those facilities have been provided with electronic equipment, while in many other hospitals, expensive medical equipment lie idle as there are no skilled professionals to operate them. Thus, whatever may be the allocation, proper utilisation of budget is a must.
A study by the ICDDR,B found that Out of Pocket (OOP) health expenditure pushes four to five million Bangladeshis into poverty every year. How do you think the government should address this high cost of healthcare?
There are many community clinics in the country at the village level, but due to a lack of professional health workers, these clinics remain largely underutilised. Many of them are only capable of providing patients with primary health-related information and occasionally prescribe over-the-counter drugs. If these community clinics could be made fully operational by appointing skilled doctors and staff, the basic healthcare needs of local communities could be easily met. Also, there are many government-approved private medical college hospitals in the country which remain underutilised. If the government can make these facilities fully operational through public-private partnership, the poor and the extreme poor can have access to health services with low cost.
A recent economic report says that every year we have 10,000 fresh MBBS doctors, and in near future, many of them will have no job. While the government healthcare centres remain underutilised because of the lack of skilled medical staff, it is an irony that doctors could remain unemployed. These issues should have been addressed in the budget.
Then there is a growing tendency among people to go abroad for treatment. If these treatments can be provided in the country, people's health expenditure will surely come down.
The high price of medicine is another reason for people's increased health spending. The government has a lot to do in terms of fixing the prices of medicines. Currently, it only fixes the prices of essential drugs. But the prices of other drugs are mostly controlled by the traders. The government said it would withdraw tax on the raw materials of some medicines, for example, cancer medicines. Such decisions will only benefit the pharmaceutical industry, not the consumers. Also, medicines that are exported to the foreign market and those that the local people get here are not of the same quality. The government needs to ensure that the patients get quality medicines at a cheaper rate.
The high health expenditure of people can be cut down through proper policy initiatives and adequate investment. Sadly, the proposed budget has failed to address these important issues.
With the share of budget in the health sector decreasing, how will the government ensure Universal Health Coverage (UHC) and health insurance for all? What about the government's commitment to achieving UHC?
I think Universal Health Coverage (UGH) is nothing but a slogan in our country. Under the UHC, people are expected to have access to quality healthcare services without being hamstrung by any financial hardship. Ironically, in our country, the healthcare sector appears to be the most neglected one. Without adequate budgetary allocation and proper planning in this sector, it is not possible for the government to provide quality healthcare to the poor and ultra-poor.
The government has been talking about health insurance for all for quite some time now. But it is not clear through which process people will get this insurance. The government is saying that the poor and ultra-poor will get a health insurance of Tk 50,000 per year. But where will they get this service from? The public sector is already overcrowded. So, it is clear that people will have to get this service from the private sector. But the private sector does not have the capacity to provide healthcare facilities at the rural level due to lack of infrastructure. So there is hardly any scope for our people to have insurance coverage or affordable quality healthcare.
According to a recent study, maternal mortality rate in Bangladesh is not decreasing. Without prioritising the health sector, will it be possible to achieve the SDGs by 2030?
Improving healthcare facilities for people is crucial if we want to achieve the SDGs by 2030. In order to achieve SDG goal 3, maternal mortality rate has to be reduced to 70 per every 100,000 live births. A recent study has found that the rate is not decreasing. There are enough reasons why it is not decreasing. Women in remote villages are hardly getting any antenatal and postnatal care as the healthcare facilities there do not have professional health workers. We do not have enough trained midwives to provide necessary assistance to the expecting mothers. We need to upgrade this service. And for that, we need to invest more in improving the quality of midwifery service. Otherwise, achieving SDG 3 will be a big challenge for us. At the same time, the overall quality of healthcare needs to be improved. The government earns crores of taka in revenue from this sector. Thus it should be committed to providing people with quality healthcare.