Health training cost leaps five folds but for fewer staff

The health ministry in 2017 took up a five-year training programme to develop skills of doctors, nurses and paramedics in family planning and has spent as much as five times the allocation on paying honorarium to trainees.

The costs have jumped more or less across all segments of the programme from refresher training, training in postpartum family planning, overseas training to regional workshops, but those have only covered one-sixth to half the targeted number of healthcare professionals.

More than Tk70 crore was allocated for training and workshops when the Clinical Contraceptive Services Delivery Programme was approved in 2017, but the Implementation Monitoring and Evaluation Division (IMED) that dug out the anomalies anticipates that the costs will rise manifold.

Director of the Operation Plan Nurun Nahar Begum said an increase in the salaries was the reason for the rise in honorarium. For example, each doctor received Tk1 lakh more than the allocation for overseas training.

"But the total expenditure on the skill-development purpose will not rise because the training programme will be cut short," she said.

The people, who are closely associated with the programme, said changes in grades and salaries did not justify a whopping 552% jump in the payments given to trainees.

The latest national pay scale was introduced in 2015, but it does not allow more than 10% yearly increment for government employees in any of the grades. In case of the maximum increment, salaries would go up by about 46%. If an official has been promoted, he gets a salary higher by about 20-30% at best.

A member of the Programming Division of Planning Commission, Mohammad Jainul Bari said the cost of training and allowance and other expenditures of the programme had been set in consistence with the new pay scale.

"Honorarium or other allowances are not likely to increase in a programme that was approved in 2017," he added.

When The Business Standard returned to Dr Nurun Nahar for an explanation that would explain the rising costs, she said the expenses had been fixed according to the third Health, Population and Nutrition Sector Development Programme (HPNSDP). So, when the implementation of the fourth HPNSDP began, the cost of honorarium and allowances went up, she added.

On condition of anonymity, an official of the planning ministry said the fourth population and nutrition development programme was given the go-ahead at the Executive Committee of the National Economic Council in March 2017, whereas the Clinical Contraceptive Services Delivery Programme got the approval in June.

All the organisations under the health ministry had been well aware of all the developments while drafting the training programme, he added.

Surge in expenditures

The programme had Tk10.80 crore allocated for overseas training of 300 physicians, which has remained suspended for the pandemic. Before Covid-19 broke out, 117 doctors toured India, Thailand, Nepal, Indonesia and Sri Lanka for 7-10 days to gain experience of how the densely-populated nations tackled the issues of family planning. They also toured three developed countries – Brazil, Canada and Italy.

According to a report prepared by the IMED, domestic training tied to postpartum planning had also seen an 129% increase in expenditure.

Half the targeted number of doctors have been trained at a cost of Tk5.10 crore while the total expenditure for the purpose was set at Tk4.57 crore.  

At the time when the ministry has already spent much more than the budgeted funds, the overall progress in the implementation of the programme is low. For example, training of paramedics in long term and permanent family planning services has been implemented by only 1.96%. 

Not a single paramedic has received training under the programme while it had aimed at developing the skills of 500 paramedics.

The programme did not have any fund set aside for payment to consultants but Tk17.50 lakh has been spent in the current fiscal year, which, according to the IMED, is a breach of financial discipline and planning. 

The report says training is not provided based on any need analysis. Moreover, the office implementing the family planning programme does not have any data on who received which training, where and when. There is not even a list of the trainees. 

Jainul Bari, secretary of the planning division, said expenditure should no way surpass the allocation. In case a bigger fund is required, the proposals have to be revised.

In times of emergency, the authority spends more than allocations, but if irregularities are found, there is scope of action against those following an audit, Jainul said.   

TIB Executive Director Dr Iftekharuzzaman said that syphoning off of funds from health programmes had become a practice.

"It is not enough to identify irregularities in the programme. The IMED has to identify and bring to book the people involved."