Reform report lacks clear roadmap, prioritisation: Health economists

The country's first-ever health sector reform report by the reform commission has identified critical issues in the healthcare system. However, health economists have raised concerns about the report's lack of a clear roadmap and prioritisation of recommendations, which they say could hinder effective policymaking.

Speaking at a South Asian Network on Economic Modelling (Sanem) webinar titled "Health Reform Commission Report: Quick Fixes or Transformation," held over Zoom this afternoon (18 May), health economists stressed the need for clear priorities and implementation to bring real public benefits.

Shafiun N Shimul, professor at the Institute of Health Economics, University of Dhaka, and honorary director of Sanem, said, "The 322-page report contains 32 major recommendations. While the recommendations mention which ones are to be implemented in the medium and long term, they do not specify which should be done first.

The broad focus on primary care is a positive aspect. However, the report does not clearly explain how changes will happen through specific service delivery approaches

Prof Shafiun N Shimul of Institute of Health Economics, DU

"For example, should the Health Service Commission be established first, or should personnel recruitment through the PSC (Public Service Commission) come first? There is no roadmap to determine the order of implementation. It also does not mention how the expenses will be managed."

He added, "A major concern is whether this report will be understandable to policymakers. The broad focus on primary care is a positive aspect. However, it does not clearly explain how changes will happen through specific service delivery approaches.

"There is also no explanation of how public-private partnerships will be implemented, nor any discussion on how the private sector can be regulated. Financing relies heavily on sin taxes, with no insurance roadmap. The focus is on filling vacancies rather than reform. There is no e-health strategy or funding.

"The report does not say what should be done in hard-to-reach areas. There is no discussion on mental health or geriatric health either."

Shimul further said, "Community clinics did not receive due importance in the report. While there is existing infrastructure for community clinics, though questions may arise about whether people actually receive services, the focus should be on how that structure can be effectively used. This aspect may have been downplayed, possibly due to political reasons."

"It would have been better if this government had started a culture of meritocracy," he said. "If those who haven't committed any wrongdoing were used without political vengeance, it could have set an example for future governments."

He added, "Reform usually means systemic change and restructuring, but that has not happened here—this is more of a quick fix. Since everyone involved in the report is a doctor, the discussion focuses on doctors, while nurses, technologists, and other health sector stakeholders have not been addressed."

Selim Raihan, executive director of Sanem, said, "Health and education should be viewed as investments—the returns come later. Sri Lanka invested 30 years ago and is now seeing the returns. Though spending on health is low, corruption is high. If those running the country have no real commitment to the health sector, the crisis will not end."

He added, "While the commission did not provide a roadmap, the government must do so. The ownership of this report does not lie with the government alone—it also belongs to the political parties. Unfortunately, we have not seen much indication of that so far."

Mahtab Uddin, assistant professor of Economics at the University of Dhaka and research director at Sanem, remarked, "The criticism of the reform commission's report is constructive. We hope this criticism is taken seriously and that even partial implementation of the recommendations brings benefits to the general population of the country."

The commission submitted its report to the chief adviser at his official residence, Jamuna, on 5 May.