Health, nutrition prog seeks rise in cost, tenure despite poor progress

The fourth health nutrition and population sector programme, involving over Tk115,486 crore, has been witnessing far more expenses on operation than on development since 2017 when it came into effect.

As a result, many targets under the mega programme have still remained unattained.

Now, the health ministry seeks a one-year extension to the five-and-half-year programme that faced Covid-led obstacles to implementing some of its projects. The programme is supposed to end this July.

Again, the ministry seems to be sticking to its trend of expenditure as shown by an analysis of the health ministry's proposal for spending 34% of the additional allocation on revenue – salaries and allowances etc – but only 13% for development.

The ministry recently sent the first revision of the proposal, estimating the cost at around Tk145,935 crore, to the Planning Commission. The scheme will see a cost hike of more than Tk30,448 crore for its completion in the extended period.

The proposal will be placed before the meeting of the Executive Committee of the National Economic Council today for approval.

Over the last five years, the health sector saw an expense of only around Tk28,326 crore, which was over 63% of the total development allocation. In this situation, the Planning Commission questioned the rationale of the proposal for additional development expenses.

The analysis of the programme's progress report shows that spending on sectors, such as human resource development, skills development and training, is far below the allocations, while there has been significant progress in sub-sectors, such as physical infrastructure development.

Foreign aid not increasing

In this mega health sector programme, foreign aid amounted to only 16.32% of the total expenditure. The amount remains at only 12.96% in the revised proposal.

The foreign assistance increased by Tk61 crore to Tk18,908 crore though it decreased in percentages. 

However, the Planning Commission has also raised the question of how much of this assistance will be released. 

According to the Project Evaluation Committee (PEC) meeting, the health ministry got funding commitments of over Tk14,977 crore, but the commission wanted to know where the remaining Tk39,10 crore or $460 million will come from.

The ministry, however, said discussions are underway with various countries and development lenders, including the World Bank, the Asian Development Bank, China and Korea in this connection.

A total of 16 donor countries and firms are financing the project.

Dr Syed Abdul Hamid, a professor at the Institute of Health Economics at Dhaka University, told The Business Standard that slow implementation of development activities delays the people's benefits.

Authorities have failed to impose higher importance on the projects and programmes related to healthcare services in the pandemic time. As a result, opportunities to improve healthcare have been missed, he also said.

He further said the regular expenditure was uninterrupted in the Covid-19 period and it increased due to the new recruitment of doctors and other Manpower. 

He stressed accelerating projects regarding training and infrastructure development.

Mosammat Nasima Begum, member of the Socio-Economic Infrastructure Division of the Planning Commission, said despite the establishment of the huge infrastructure of healthcare services in recent years, quality services remained unattained due to a lack of human resources and quality equipment.

She stressed establishing modern equipment on existing infrastructure and operating and maintaining it with skilled manpower.