'We remain poor in health budget despite fast economic growth'

The government's focus on health has so far been limited to acknowledgements of the severity of the Covid-19 outbreak which has also been reflected in the proposed health budget. 
 
Experts spoke about the flaws in the country's health system and the immediate measures needed to overcome the health and economic crises caused by Covid-19 in a virtual discussion organised by Health System Improvement Forum on Sunday.
 
Dr Ziauddin Hyder, senior health specialist of the World Bank, moderated the programme.
 
Considering the healthcare need amid the outbreak, "The increase in health budget this year is negligible," said Jahangir Khan, senior health economist at Liverpool School of Tropical Medicine.  
 
Compared with the previous year's budget, there has been no change in the proposed budget for the fiscal year 2020-21, Jahangir said.
 
"The allocation is around 5 percent of the total budget this year too."  
 
"About 78 percent of it will go to health service while 22 percent to medical education and family welfare," Jahangir said.
 
"An extra Tk10,000 crore has been set aside for Covid-19 but how and where the money will be spent to benefit the health services has not been laid out."

"Only 3 percent of all public expenditures goes to the health sector, which is the lowest in South Asia. But the out-of-pocket expenditure is the highest here – 74 percent," Jahangir pointed out.
 
"We remain poor in the health budget despite fast economic growth. The integration of the private healthcare sector with the public healthcare sector is at an alarming state and we failed to ensure access to healthcare for the commoners."
 
"Shockingly, the scenario has not changed even when an outbreak has struck the nation hard," Jahangir added. 
 
The budget lacked the money distribution details – where it will be spent and how – said Economist Hossain Zillur Rahman. 
 
"And the way the finance minister questioned the health ministry's ability to spend the money while ensuring good governance and accountability proves to be a valid one when the pandemic has laid its failures bare."
 
But the budget should have mentioned the vulnerable areas in or weaknesses of the health sector – where reform is needed and how the health ministry can be strengthened – Hossain Zillur said. 
 
Unfortunately, the government could not decide what areas in the health sector need attention and investment to deal with a pandemic that broke out about three months ago, he added. 
 
There is a chance of wastage of money and corruption if the authority cannot come up with a detailed plan to use the fund of Tk 10,000 crore created for Covid-19, Zillur Rahman said.  

Rumana Huque, professor of the department of economics at the University of Dhaka, said reform in the health sector began in 1998. 
 
"The government and the development partners fund the development programmes. But the need-based assessment goes missing in the budgetary plans." 
 
Former finance secretary Mohammad Tareque said, "If healthcare is discussed on a broader spectrum, food, sanitation, hygiene and many other issues will have to be highlighted." 

"Not only curative treatment but also preventive measures should get due attention." 
 
"There should an integrated health policy, taking stock of our need and preferences – if we want universal health coverage or our public healthcare to be bolstered or to depend more on the private healthcare," Mohammad Tareque said.
 
"The biggest loophole remains at the policy level. Any policy without an action plan is no policy. As long as it remains like that, nothing will change."