8 projects on cards to fix urgent medicine shortage, ensure health staffers' salaries

The health ministry has initiated eight new projects to tackle the urgent medicine shortage, ensure employees' salaries and allowances and resolve the impasse that has gripped the sector, with most projects expected to be completed by June next year.

Ministry officials say through these projects, the ministry hopes to ensure the supply of quickly depleting medicines, vaccines and other healthcare supplies up to the upazila level.

Officials say that the recent exit from the five-year sector programme, which had been ongoing for nearly 27 years, has created a kind of stagnation in the healthcare sector. Since the completion of the 4th Health, Population and Nutrition Sector Programme last June, purchase of medicines and other supplies for the health sector has come to a halt.

They say patients at the non-communicable disease (NCD) corner of upazila health complexes are not receiving free medications for high blood pressure and diabetes.

Besides, staff at the country's 14,000 community clinics and 35 child development centres have not received their salaries for the past nine months. Due to the lack of an operational plan, many crucial programmes, such as rabies vaccines, anti-snake venom and malaria medications, are progressing slowly. Furthermore, important purchases for hospitals have been halted, affecting services.

To resolve these issues, the health ministry has set a target of completing the approval process for the new projects by June. To achieve this, the ministry has instructed the relevant departments to prepare project proposals and send them to the health ministry by 31 March.

Officials say that after review, these projects will be submitted to the Planning Commission for approval. Once approved by the Executive Committee of the National Economic Council (Ecnec), tenders will be invited for the procurement of medicines and other services. This process is expected to address the impasse in the healthcare sector.

Professor Sayedur Rahman, special assistant at the Ministry of Health and Family Welfare, told TBS, "We hope that the relevant departments will be able to send us the project proposals by 31 March. However, due to the Eid holidays, there may be a 15-day delay. The project costs will be known once the DPP is finalised."

Exit from five-year sector programmes

In June last year, after the completion of the fourth health programme, the health ministry initially proposed the Fifth Health, Nutrition and Population Program with a budget of Tk106,000 crore for the next five years.

However, in a subsequent inter-ministerial meeting at the Planning Commission, it was decided to treat it as the final sector programme and implement it with instructions to create an exit plan.

But in February this year, the ministry decided to completely withdraw from the programme and initiated the development of a two-year exit plan until June 2026.

Officials say as part of this, instead of the five-year sector programme, a two-year exit plan is being formulated.

Professor Sayedur Rahman said, "Through the sector programme, we had moved into a comfort zone, and now we need to come out of it. This will now be purely state-owned and under national control.

"One director will handle everything. Previously, there were line directors, two programme managers, and six deputy programme managers, but this will no longer be the case. It will be entirely a government structure, and it will become self-reliant."

He added, "All critical health activities will be funded by the state. For expansion, we seek the participation of development partners, but not for regular day-to-day activities."

Separate projects with foreign loans

Officials at the Health Services Division stated that the funds initially allocated by the World Bank for the fifth health programme will now be used for new projects.

One or two projects will be implemented over a five-year period with the loan assistance of $379 million from the World Bank and a $25 million grant from GFF.

Additionally, officials mentioned that a separate project will be developed for urban health, in line with the World Bank's contract terms. The development project proposal (DPP) for these projects, with technical assistance from the World Bank, will be completed by 31 March 2025.

With funding and technical assistance from development partners such as FCDO, SIDA, UNFPA, WHO, GAC, GAVI, and UNICEF, technical and investment projects will be launched as needed, with the relevant development partners' support, as per the officials.

Health centres awaiting medicine

Since exiting the five-year sector programme last June, the health sector has faced a significant crisis. Health centres are now waiting for new supplies of medicines.

TBS Jashore correspondent reports that in Monirampur upazila of the district, the supply of free medicines has been halted for three months at 17 union health and family welfare centres. Patients are returning empty-handed, after receiving only basic verbal medical consultations.

Additionally, a long-standing shortage of staff has exacerbated the situation. As a result, the government's initiative to deliver healthcare services to people at the grassroots level is not reaching its full potential.

According to sources, union health centres primarily focus on birth control, maternal and child health, and adolescent services, including reproductive health services for teenagers. Although birth control is the main service, patients are not receiving birth control pills from any of the centres.

Officials say the health centres are supposed to provide 28 types of medicines, including iron, folic acid, vitamin B complex, calcium, deworming tablets, paracetamol, metronidazole, Pentonix-20, and histacin.

However, the allocation of medicines is lower than the demand sent each month. Essential medicines have not been supplied for the past year, with a small batch arriving last November, but since then, supply has been halted.

Shrabanti Das, family welfare visitor at Monirampur Sadar Union Health and Family Welfare Centre, said that previously, 30-40 patients visited the centre daily. Due to low allocations, a month's supply of medicine used to run out within two weeks.

"Now that patients are aware of the medicine shortage, fewer people are coming for treatment. Those who do visit receive only verbal consultations, as no medicines are available," she said.

The same situation prevails in community clinics. In Lakshmipur, medicines were last supplied to community clinics in September last year. Since then, for six months, there has been no new supply. Despite patient visits, the lack of essential medicines is disrupting healthcare services.