Health needs a bigger budget but cannot spend the amount allocated. Why?

In the midst of a pandemic, when for two years all we have talked about is improving our health infrastructure, it is rather shocking to find out that the Health Services Division, out of the 5.8 percent of the ADP (Annual Development Programme) budget allotted to health services, had spent only 6.4 percent between the months of July and November last year.

This is of course nothing new.

In FY20-21, it received a budget of Tk11979.34 crore (5.72 percent of the total ADP) and spent only Tk6937.83 crore, which is only 57.91 percent of its total allocation.

Our allocated budget for health is already inadequate both in ADP and fiscal years' budget break down. But even then, we are repeatedly failing to use that budget. Even a pandemic wasn't enough to make an exception. However, there are a few reasons that I believe are responsible for this legacy of failure. Let's talk about these one by one.

The first thing for having a surplus budget is our lack of planning. Planning needs foresight to understand what is important for the present and the future, but none of our planners have this.

Why?

Basically, a line director has to plan, propose, and ask for the budgeted amount from the ministry for its department. However, most of our line directors are a misfit for their positions. The line directors designated for each department do not know their assigned department well. Until they know their sector well, how will they plan, make interventions and then execute those? And so we suffer from the consequences.

It is not a crime to have an initial lack of knowledge about the responsibilities of an assigned department, but they must learn as they go on. We can educate them by forming a panel that would brief the directors about the current scenario and what can be done. Unfortunately, no such steps were ever taken and we have seen the result in this pandemic.

During this pandemic, if the line director of public health had taken enough steps to plan, we could have used a minimum 50 percent of the ADP budget in vaccination campaigning, awareness and many more, but we did not. Even now as the Omicron variant is spreading, we still do not have any solid plan.

When I joined as the director of communicable disease control in 2011, the allocated budget for my department was only Tk45 crores. After joining, I revalued the budget and made it Tk55 crores. I increased the allocation three times more for my department in three years. It was because I knew my responsibilities well. Hence, I could ask for more budgets in different important areas and the ministry had to approve that budget.

Since I left in 2015, no new program has been taken in all these years. Did we not need new programs and planning in the last six years? We did but afterwards, the department seemed to lack knowledge about the scope or problems to work on further. Thus, we did not see any incremental budgeting.

Now let's focus on one of the departments where we spend the most because it will help us to analyse the breakdown. In the department of hospital service management, we spend a considerable amount of money every year, but this sector is not doing well either. What is wrong?

The issue is that a huge amount of money is spent on buying machinery, which is not necessary. We need a solid procurement plan that considers the price, specification, and necessity to mitigate this problem. As we do not have any procurement plan we have a gap between our needs and the unnecessary machinery we have.

Instead of buying necessary machinery or following up on our procurement list, we keep buying machines offered by the contractors. In reality, we do not even need the machinery in most cases. This highlights two things: the lack of transparency and knowledge of the designated officers in the system.

This habit of buying unnecessary machinery has been ongoing for years, but it is a very tricky thing to pinpoint. No one can identify them from outside the system. But whoever has worked in the higher health department positions has indeed faced this dilemma.

Another thing that I do not understand is that if we have a surplus budget, why do we not spend that on our out-of-pocket expenditure? We can easily invest a huge amount of our funding in medicines for diabetes, hypertension, and cancer patients.

There are so many sectors that we can work on. For example, according to our highest political commitment, our district hospitals should have all the modern hospital facilities. If we could ensure a good quality service at the district level, we could easily spend a huge amount of our health budget and cut down our dependency on private hospitals. If we can already provide good service, why would people spend their own money on private hospitals, out-of-pocket expenditure or go abroad?

In the last few decades, we have seen the growth of private hospitals. What does that indicate? It means that we have an interest in health, but our public hospitals fail to provide services. In public hospitals, there are 40 thousand vacancies for caregiver employees. When we need to create more posts for hospitals, we are unable to meet the vacancies.

Also, last but not least, there is a communication gap between our health ministry and the departments under this ministry. It is another valid reason for having a surplus budget. As most people in higher positions do not understand the urgency, they often make us wait. This results in a delay in executing our plans because we do not get timely permission.

While this is the situation, we cannot be very hopeful of seeing a change overnight. However, if we address the problems and focus on solving those in this new year, maybe we can hope for a better year ahead.

Be-Nazir Ahmed, Former Director of Disease Control at Directorate General of Health Services. Illustration: TBS