Govt outlines Tk16,738cr health, nutrition programme for five years

Infograph: TBS

Highlights:

• Health ministry scraps sector programme after 27 years' operation
• New five-year, Tk15,123cr project focuses on supplies, vaccines
• Two-year bridging plan targets infrastructure, HR, service improvements
• Sector programme criticized for redundancy, overlapping, dual administration
• New projects will target nutrition, immunisation, and system capacity
• Priority regions: Chattogram, Sylhet due to poor health indicators

Marking a formal exit from the sector-wide programme, the health and family welfare ministry has instead prepared a five-year, Tk15,123 crore comprehensive scheme prioritising medical and vaccine supplies at public health facilities across the country, according to planning ministry officials.

In addition, a two-year stopgap programme has been undertaken primarily to complete physical infrastructure and improve human resource management as incorporated in the fifth phase of the Health, Nutrition, and Population Sector Programme (HNPSP), which has been scrapped by the interim government.

Together, the two schemes make up a Tk16,738 crore initiative that will replace the foreign-aided HNPSP, which continued for 27 years. Its fourth phase ended in June 2024, and the now-scrapped fifth phase was approved with an allocation of Tk1.06 lakh crore to support the country's health and nutrition services for the next five years.

But the health ministry finally decided to discard it as the planning commission finds the sector-wise budgeting approach of the HNPSP proved less effective as it caused redundancy, overlapping and wastages of resources.

Instead, the ministry decided to go for specific projects, aligning both revenue and development expenditures to avoid redundancy and ensure better healthcare services to citizens at rural and urban health centres all over the country.

Professor Dr Sayedur Rahman, special assistant to the chief adviser at the Ministry of Health and Family Welfare, told TBS that the government is planning to move away from the current sector-wide programme approach due to inefficiencies and overlapping administrative structures.

"Many activities under the sector programme fall under both the operational and development budgets, which leads to duplication, overlapping, and wastage of resources. It also creates a dual administrative structure," he said.

"To address these issues, we are planning to exit the sector programme. Instead, development activities will be carried out through a number of standalone projects. We expect all bridging projects to be approved this July."

Officials say under the proposed new structure, the Health and Nutrition Services Improvement and System Strengthening project will focus on enhancing nutrition, immunisation, non-communicable disease screening, and drug availability at the field-level healthcare centres.

Another project, Essential Unfinished Activities under PED, HEF, IFM, and SWPMM, will focus on improving infrastructure and services at district and upazila hospitals.

In addition, a third project proposal is in the pipeline, which aims to support critical functions of the Directorate General of Health Services, the Directorate General of Drug Administration, and the Community Clinic Health Support Trust.

According to sources at the Planning Commission, the proposals for the first two projects have already been submitted for approval and will soon be placed before the Executive Committee of the National Economic Council (Ecnec) for final clearance.

Health, nutrition system strengthening project

According to officials, the proposed Health and Nutrition Services Improvement and System Strengthening project will work to strengthen referral systems and build capacity to tackle health risks arising from climate change.

Out of the project's estimated cost of Tk15,123 crore, Tk8,664 crore is expected to come from government funds, while the remaining Tk6,459 crore will be sourced from foreign grants and loans.

While the project is designed to improve healthcare services across all divisions, special priority will be given to Chattogram and Sylhet, where child and maternal mortality rates are relatively higher and other health indicators lag behind.

Around 60% of the total budget has been allocated for medical and surgical supplies, medicines, and vaccines.

The project is scheduled to run from July 2024 to June 2029.

Project planned to complete unfinished health infrastructures

The government has planned a new project titled Implementation of Essential Unfinished Activities under PED, HEF, IFM, and SWPMM as an alternative to the fifth HNPSP.

Under this project, various initiatives will be undertaken to improve health infrastructure, supply furniture, and strengthen financial and human resource management in selected upazilas, municipalities, and city corporations across all 64 districts.

As part of the project, six under-construction upazila health complexes will be upgraded to 50-bed facilities, and another six to 100-bed facilities. Additionally, seven old health complexes will be reconstructed, and seven new divisional health offices will be built.

The project also includes the continuation and evaluation of the Shasthyo Suroksha Karmasuchi (SSK), a health protection scheme for families living below the poverty line. Initially piloted in Tangail in 2016, the programme is now being implemented in both Dhaka North and South city corporations and six other districts – Barishal, Barguna, Lakshmipur, Manikganj, Lalmonirhat, and Kurigram.

The project aims to complete the piloting phase, conduct impact studies, and develop an acceptable model based on the findings.

A significant portion of the budget, Tk854.75 crore, has been allocated for the construction of non-residential buildings and Tk598.81 crore will be allocated for procurement of furniture. Funds have also been proposed for land acquisition, and the purchase of electrical and office equipment.

The project is scheduled to be implemented from July 2024 to June 2026.