Budget must focus on bolstering health system

Health experts and economists said the monumental challenge of balancing between the public health and economic health of Bangladesh awaits the upcoming national budget.

While speaking at a pre-budget webinar Tuesday hosted by The Business Standard, they advocated for innovation in health security and economic security. Besides, they insisted on increasing allocations for research and arranging critical medical supplies such as Covid-19 testing kits, oxygen supply and Intensive Care Unit (ICU).

On top of this, they also recommended public-private partnership to tackle the pandemic-led crises.

Dr Zahid Hussain, former lead economist of the World Bank Dhaka Office, moderated the programme while The Business Standard Editor Inam Ahmed also joined it.

The experts said the infection rate will fluctuate owing to the preventive measures as the virus is not going away soon. People will have to wear face masks and follow virus safety guidelines to tackle the brutal resurgence in infection.    

Professor Nazrul Islam, noted virologist and also a member of the National Technical Advisory Committee on Covid-19, said the infection rate had declined slightly after the recent lockdowns. It is better not to be encouraged by the reducing infection rate as we have seen what happens when we get excited.

"We have to try to prevent the pandemic and there are two ways to do so. One is mechanical prevention – wearing masks and maintaining social distancing. The second one is biological prevention through mass inoculation," he said. 

Apart from prevention, there is the part of treatment to cure the infected. We lack in this part as our medical facilities are not sufficient. This should be addressed immediately, he noted.

Prof Nazrul said there are already many variants in Bangladesh which are more virulent and can weaken the vaccine efficiency. But there is no variant which can dodge face masks and social distancing measures.

Mentioning in the webinar that the health system of Bangladesh has never been good, Prof Dr Mohammad Shahidullah said, "In the last 50 years, all the decisions in the health sector have been ad hoc basis. We do not proceed with a long term plan."

"So far we have no plans. Our community clinic is followed by union health centre, then upazila health centre, district hospital, medical college and then institute. This ladder is there, but it is not clear who is in charge of this ladder."

Prof Dr Mohammad Shahidullah said the next budget should include health system reform.

He said, "There also should be proper management of the health budget. Many of our equipment have been bought with crores of Taka. But in many cases, the root-level medical facilities did not even receive those as they neither know how to use it, nor they have the manpower to run those."

Prof Shahidullah thinks Bangladesh may need more oxygen supply in upcoming days. He said, "Let us increase the production. There should be allocations in the next budget for building oxygen plants in major hospitals. It not only will help us in the pandemic, but also will remain as an asset later."

He thinks proper management can yield better progress in the health sector even within the limited budget.

On whether the spread of the virus will increase further in next Eid, Prof Dr Mohammad Shahidullah said Eid rush to ancestral home certainly would deteriorate the situation.

Asked why the garment sector has less virus infection, he said the owners of the ready-made garment factories maintained better health safety than others.

"I repeatedly told our shop owners association to follow the apparel makers' lead after reopening. I requested them to strictly follow no mask no service rule, but they are not listening to that," he added.

In the meantime, Dr Ahmed Mushtaque Raza Chowdhury on bureaucratic tangle over the pandemic management said civil society members have worked jointly with the government on all major disasters in Bangladesh so far. But the civil society in Covid-19 pandemic management is absolutely absent.

"The government is working alone, and there is also no complete approach. Not all ministries are working in a synchronised way. We cannot deal with the pandemic unless everyone works together."

He advocated for engaging the non-governmental organisations in pandemic management.

Ahmed Mushtaque Raza Chowdhury said that 70 lakh people have been vaccinated so far while most of them are middle-class people. 

"If this inequality cannot be eliminated, the herd immunity that we are going to create through the vaccine will not happen. All types of people need to be vaccinated quickly," he added.

Raza Chowdhury said that oxygen should be given priority in the budget. The budget for the health sector needs to be increased.  

"It goes without saying that there is no research in our country. We must conduct research. We need to invest in primary health care," he further said.

On the possible changes in the situation in the next three to six months, Dr Shafiun Shimul said there is some impact on the infection as public transport is closed. 

"The situation will remain the same till May. Then if public transport continues then the infection may increase again. This increase may last until the end of June. The problem in our country is that binary decisions are always made. If there is no lockdown, everything is opened," he added.

Vaccines were once produced at the Institute of Public Health in Bangladesh. Smallpox has been eradicated by vaccines produced there. Experts believe that modernisation of the government vaccine manufacturer is now necessary to produce coronavirus vaccines.

Professor Nazrul Islam said, "We don't have any system to test whether the vaccine we are bringing in is suitable or not. There is no reference laboratory. The budget should allocate for the development of government institutes producing vaccines."

Although the allocation in the health sector is less, many times the budget money is not spent. 

In this regard, Shafiun Shimul said, due to a lack of capacity of managers in the health sector, the money allocated in the national budget is not spent. 

"There is a shortage of health managers in budget management. There is a gap between the finance ministry and the health ministry. The Ministry of Finance does not understand the problem of the Ministry of Health. So money is not allocated against many of their proposals. He thinks that keeping someone from the finance ministry in the health ministry will solve this problem."

Commoners are in financial trouble to cover the cost of Covid-19 treatment. Shafiun Shimul thinks that to solve this problem, the private sector should control the cost by dividing it into several tiers.

He said now there are coronavirus patients in almost every house. People who are infected need to be treated. Many have to sell assets to spend seven to ten lakh taka. 

"Irrational use of drugs should be stopped. In addition, those who are providing emergency services should be brought under the protection scheme. In addition, private hospitals need to negotiate with the government to reduce costs," he added.

The irrational use of remdesivir in Covid-19 treatment is on the rise. That is why the cost of medical treatment is increasing. 

Dr Mohammad Shahidullah said the Technical Advisory Committee will discuss the rational use of remdesivir.

Experts think that the coronavirus pandemic should be kept in mind in this year's budget. There must also be a budget for hygiene. In addition, the budget should have an allocation to increase the number of ICU experts in hospitals.

The budget must have an allocation to increase the testing capacity. There should be a plan for vaccination and from which countries vaccines will be imported and when they can be produced in the country. The government must mention what kind of support it will provide to vaccine producers. Experts believe that if there is a lockdown, the management of food for the poor and quarantine expenses should be kept in the budget.