Poor allocation despite promises to ensure quality healthcare

The government aims to ensure quality healthcare for all, but a paltry growth in health sector allocation in the proposed budget does not reflect its agendas of achieving universal health coverage, and decreasing the out-of-pocket expenditure.

According to healthcare experts, currently, people are struggling to meet their living expenses due to a soaring inflation. A conventional health budget like the one proposed for FY24 will not decrease out-of-pocket expenditure. Rather, commoners will witness a rise in health expenditure.

In his budget speech on Thursday, Finance Minister AHM Mustafa Kamal said, "Our foremost objective is to ensure quality healthcare for all citizens. Consistent with this objective, we are providing health care across the country through 31 operational plans under the Fourth Health, Population and Nutrition Sector Programme (HPNSP)."

However, allocation for the health sector in the budget proposed for FY24 was only around 5% of the total budget, which was around 5.44% in the proposed budget for FY23.

The government plans to allocate Tk38,052 crore for the health sector in FY24, which is 3.23% higher than the last fiscal year's initial allocation of Tk36,863 crore. Allocation for that sector in the revised budget for FY23 was Tk29,749 crore.

In his budget speech, Finance Minister AHM Mustafa Kamal proposed reducing import duty on 100 more raw materials of cancer medicines, silicon tube used for making intravenous cannulas, and three raw materials of diabetes medicines.

With an aim to protect women and children, he also proposed to extend the current VAT and supplementary duty exemption period on import of raw materials used in the sanitary napkins and diapers.

The proposed budget also exempted VAT at the production stage on antimalarial and anti-tuberculosis drugs.

Monjurul Alam, director of Global Business Development at Beacon Pharmaceuticals, told TBS, "The government's latest decision will help cancer and diabetes patients immensely. In our country we do not increase medicine prices that much. However, the prices of raw materials used in medicines have increased due to the increase in the dollar exchange rate, which in turn forced us to hike some medicine prices.

"A reduction in import duty for raw materials will help us not to raise the prices of certain drugs, or keep them the same. It will help us provide patients with drugs at affordable rates."

To ensure better medical services for the public, there is a proposal to increase the 50-bed upazila health complexes to 100-bed healthcare facilities, and the district level government hospitals from 100-bed clinics to 250-bed healthcare facilities.

The proposed budget also continues providing funds for the projects to set up medical universities in Rajshahi, Sylhet, and Chattogram, and medical colleges in Magura, Netrakona, Naogaon and Habiganj districts.

Biomedical Scientist Professor Liaquat Ali told TBS, "The shrink in health budget's percentage in the total budget seems symbolic. It appears that this sector is being given less importance. The 8th Five Year-Plan proposed to make the allocation for the health sector 11% of the total budget, but it has been reduced from 5.44% in FY23 to slightly below 5% in FY24.

"Primary health care is neglected. The government is talking about setting up community clinics, but that has not been focused enough," Professor Liaquat Ali, former vice-chancellor of the Bangladesh University of Health Sciences.

Currently, treatment receivers bear around 69% of the country's total health expenditure, said sources at the health ministry.

Professor Liaquat Ali said, "Our policies mention reducing out-of-pocket expenditure, which requires an emphasis on the prevention of diseases. Moreover, we need initiatives to stop over-the-counter sell of drugs and over-prescribing.

"Currently, the primary health care-centres focus mainly on maternal and child health care, not the prevention of non-communicable diseases," he said, adding, "The budget does not contain specific directions for achieving universal health coverage by 2030."