Health gets bigger focus, but details lack clarity

As the budget for FY2020-21 was placed on Thursday, Bangladesh had just reported 37 more deaths from the novel coronavirus and 3,187 new cases of infection.

The number of infections reached the single-day highest on June 10, and the highest death toll of 45 was recorded on June 9.

Under these grave circumstances, Finance Minister AHM Mustafa Kamal declared that the proposed budget will prioritise health for recovering from the current economic crisis.

Despite health being the government's first pillar of focus in its road to recovery, it is not clear how this budget will be spent to rein in the ravaging coronavirus pandemic.

The government pledged to revamp the public health sector in the next fiscal year with an annual budget increase by 23 percent from the revised budget of this year.

Apart from the allocation of Tk29,247 crore, Finance Minister Mustafa Kamal in his budget speech in parliament on Thursday said Tk10,000 crore will be kept aside as a "lump sum" to tackle any emerging situations tied to healthcare for the Covid19.

The allocation of funds lacks much needed details, considering that Bangladesh's fate, and the life and livelihood of its people will largely depend on the capacity and efficacy of the country's health care system.

Moreover, a fragile healthcare system will discourage investors to come to Bangladesh.

"I am disappointed to see that the government did not lay out the priority areas for spending. This year's budget presentation was an as-usual affair, as in the previous years," said Mushtaque Chowdhury, founding dean of the Brac James P Grant School of Public Health.

To curb the virus transmission and treat the infected, Kamal said programmes had already been taken up worth Tk5,500 crore, adding, "The government will do whatever is required to be done to address the pandemic."

But the lack of proper planning risks wastage of the fund through unnecessary spending and corruption, said experts.

Over the years, public health has been neglected, with annual budget hovering over 4-5 percent of the total budget. The amount has never surpassed 0.9 percent of the Gross Domestic Product.

"It is worth mentioning that currently 13 ministries and divisions are implementing programmes related to health and family welfare," said the finance minister.

He added that in total, as much as Tk41,027 crore will be allocated for the public health sector for the next fiscal year, which is 1.3 percent of the GDP and 7.2 percent of the total budget.

The best utilisation of the money depends on realistic projections of the people to be infected over the year and the resources needed for testing and treatment.

"These assumptions and information should clearly be mentioned in the budget speech, so that these numbers and the concerned budgetary allocation can be examined thoroughly," said the Centre for Policy Dialogue, a think tank, ahead of the budget presentation. 

The minister also did not mention any reform initiatives to ensure accountability in the health sector plagued with corruption.

Around 57 percent of the proposed fund will be spent on operation, and the rest on development purposes.

However, experts think the government should focus more on how to make the existing infrastructure functional with skilled manpower.

After the pandemic broke out in the country in March, the government recruited 2,000 doctors and 6,000 nurses on an urgent basis. Healthcare workers and lab technologists were hired as well.

Still, it has proved to be an uphill task to expand the testing capacity and treatment with the pace of the infection spread.

But Kamal on Thursday reiterated that the government was prepared all along to deal with the health crisis.

The primary healthcare system should be strengthened to make healthcare accessible to all at the community level, said Prof Muzaherul Huq, former adviser of the World Health Organization's Southeast Asia region.

Rural establishments should get more investment, he said, adding, "The pandemic can be managed well if a referral system is in place and effective with community clinics, upazila and district hospitals capable to function fully.

The money is adequate to overcome the health crisis inflicted by the virus only if the government can plug its leakage due to corruption and other means."

Experts also stressed the need for research to derive data to help understand the weaknesses of the health system and how to overcome them.  

The FY2020-21 budget proposes an Integrated Health-Science Research and Development Fund of Tk100 crore to "develop research in the health-education and science technology sector."

A "high-powered" committee – composed of expert physicians, nutritionists, public health and sociologists – will be formed to ensure proper and effective use of the fund. Health economists, environmentalists and civil society members will also be engaged.