In November 2014, the then-health minister Mohammed Nasim announced in parliament that the process of setting up intensive care units (ICUs) and coronary care units (CCUs) for heart patients in district government hospitals would start that month.
Seven years have passed since then but his announcement has not been implemented yet.
Also, in June last year, while approving two projects at the Executive Committee of the National Economic Council (Ecnec) – that received support from the World Bank and the Asian Development Bank (ADB) – Prime Minister Sheikh Hasina directed officials to set up ICUs in all district sadar hospitals. The projects were approved in the wake of rising Covid-19 and non-Covid-19 deaths due to a lack of ICUs.
But the implementation of the projects has not begun yet.
Ecnec, in January this year, approved a revised project costing Tk6,614 crore to set up ICU beds in district hospitals and procure Covid-19 vaccines.
The National Electro-Medical Equipment Maintenance Workshop and Training Centre is a government agency tasked with repairing government hospital equipment and setting up ICUs, ventilators and oxygen lines. This was not widely familiar before the novel coronavirus outbreak.
The agency was assigned the responsibility of carrying out emergency repairs and installing ICUs and ventilators, as well as central oxygen plants, in government hospitals across the country during the pandemic.
However, the agency tasked with repairing equipment in 620 hospitals, has no transportation. It employs 83 people, including 15 engineers. It has sent a proposal to the Health Services Division to recruit another 800 workers to carry out its tasks, but it has not yet been approved.
Central oxygen line installation began in 26 hospitals in mid-2020 and the work has been completed in 14. In the remaining 12, the foundations have been laid in some while site selection is in progress in others.
In the current financial year, Finance Minister AHM Mustafa Kamal proposed setting up an integrated health science research and development fund of Tk100 crore for the development of: health, education, science, and technology research. With the approval of the Prime Minister's Office in November last year, the finance ministry sent a fund management policy to the health ministry by forming a committee headed by noted neurologist Dr Quazi Deen Mohammed.
The financial year is nearing its end but the health ministry has not yet issued a circular in this regard.
Private medical college association officials said private hospitals had been affected by the pandemic and private investment in this sector is thus stagnant.
Meanwhile, the finance ministry increased the allocation for the annual development programme (ADP) by Tk3,000 crore in the current financial year. Fearing a drop in revenue, the Finance Division reduced the government share in all ministries' development allocations by 25%, except for the healthcare sector. But due to a lack of capacity, the health ministry has been unable to spend it this time either.
The development allocation for the Health Services Division was Tk9,736 crore in the current fiscal year but only Tk1,658 crore (17%) was spent during July-January.
Meanwhile, this fiscal year's development allocation for the Medical Education and Family Welfare Division was Tk2,277 crore. Till January, Tk632 crore (28%) was spent.
Health Services Division officials said there had been financial irregularities in two Covid-19 handling projects in various purchases, including goggles and personal protective equipment. The Tk2,500 crore projects included funding of the World Bank and the ADB.
The government later made Md Iqbal Kabir, director of both projects, an officer on special duty (OSD). Anti-corruption campaigns in the health sector were also carried out for a while. Since then, the implementation of various projects in this sector started slowing down.
Health Services Division officials said there used to be large-scale irregularities and corruption in procurement for health projects. That is why many officials were interested in becoming project directors or members of tender evaluation committees.
However, since the anti-corruption drives began, the interest in becoming project directors has waned. Also, officials are reluctant to be on tender evaluation committees. Although their names are included in committees by the ministry, they do not attend committee meetings.
Additional Secretary (planning) to the Health Services Division Md Helal Uddin said one of the two projects had got two directors in succession after Iqbal was made an OSD, but neither of them performed their duties appropriately.
"Then a new project director was appointed, and he is now implementing the project properly. ICU beds will be set up in district hospitals under this project," he added.
Joint Secretary to the Health Services Division Md Mujibur Rahman said GK Shamim's organisation was the contractor of the project for setting up neuro hospitals in divisions.
"The public works ministry later cancelled the contract and is now in the process of appointing a new contractor. That is why the implementation of the project is being delayed," he added.
Officials said the situation gradually improved because some prompt action was taken. To address urgent needs, the health ministry tried to handle the situation by quickly recruiting new doctors and nurses as well as outsourcing the recruitment of medical technologists. At least 2,000 doctors and 6,000 nurses were recruited. Through outsourcing, 386 medical technologists and 2,654 lab attendants were hired.
In addition, 3,000 new posts were created in the revenue sector, including 1,200 medical technologists, 1,650 medical technicians and 150 cardiographers, said the finance minister in his budget speech. Special civil service tests are going to be held to recruit more doctors and the recruitment of 3,000 technologists is going on.
Despite this, hospitals will have a shortage of doctors and nurses in proportion to the number of patients. In particular, the number of nurses is much lower than that of doctors.
Analysts say the government succeeded in handling the pandemic over the past year as it focused fully on that. Vaccination programmes are being implemented successfully.
However, the overall state of healthcare has not improved much. Campaigns to curb corruption in this sector had to be stopped in the end due to interventions by the health ministry.
Professor Muzaherul Haque, a former adviser to the World Health Organization, told The Business Standard the novel coronavirus has taught Bangladesh to reform its health system.
He said there have been some infrastructure developments during the pandemic, including manpower recruitment and oxygen line installation, but medical services have not been brought to people's doorsteps.
There is no decentralisation of the health sector, said the expert.
"Our community clinics are doing very well but union healthcare centres are not that functional. Upazila health centres need to make better arrangements for treatment. Patients there will go to districts or divisional towns only if ICU services are needed," he continued.
"We need to make the referral system effective. Then patients' suffering and expenditures will reduce. The pressure on hospitals in the capital will also ease," added the professor.
Dr Md Ehteshamul Huq Choudhury, secretary general of the Bangladesh Medical Association, told The Business Standard the novel coronavirus has increased the country's medical capacity.
He said high-flow nasal cannulas and central oxygen lines had been set up in many hospitals for treating Covid-19 patients while several thousand workers have been recruited, including doctors, nurses and technologists.
"Preparations are underway to hold another special civil service test for doctors. Manpower recruitment in the health sector was closed for a long time. The manpower crisis has been resolved to some extent due to the pandemic. Even then, steps must be taken to reduce the doctor-nurse ratio," he added.
Ehteshamul continued, "The National Institute of Preventive and Social Medicine, and the Institute of Epidemiology, Disease Control and Research have done some research. Still we are lagging far behind in research and there should be more emphasis on this. Even if the [novel] coronavirus subsides, we may encounter more emerging and re-emerging diseases. That is why research is very important."
Prior to the pandemic, in September 2019, the Ecnec approved a Tk2,388 crore project to set up full-fledged, 100-bed cancer treatment centres in medical college hospitals in each divisional town. The buildings housing these centres will have three floors for the treatment of heart patients.
Moreover, the government is planning to set up neuro hospitals in divisional towns, five-bed kidney dialysis centres in district sadar hospitals and 50-bed kidney dialysis centres in medical college hospitals.
The Health Services Division has sent a project proposal to the Planning Commission for setting up plants for managing the medical waste generated by government hospitals across the country.
An official of the division said these plans were made before the pandemic.
"We will have to wait longer to get the benefits," he added.