Public health experts and health economists have emphasised allocation to strengthen the country’s emergency healthcare, response and preventive measures alongside raising the overall health sector allocation in the upcoming budget.

Saying that a drastic increase in the allocation for the health sector would not be a solution, they observed that a long-term plan and a steady increase in the allocation should be ensured as the novel coronavirus crisis has exposed the health sector’s vulnerability in Bangladesh.

‘The novel coronavirus has demonstrated that we have no emergency care system here at all,’ said public health expert Rashid-e-Mahbub.

‘We have to redesign our health system, taking this deficiency into account, and increase the budget on a continuous basis to strengthen the health system,’ he underscored.

Health economist Syed Abdul Hamid of Dhaka University said that the health ministry officials responsible for participating in the budget-making process were neither capable to seek budget based on needs nor had the ability to spend the allocated money.

‘Budgetary allocation is not like distributing a cake among the family members, but we have to know where the large chunks or the small chunks should go and how to swallow them,’ he said. 

The budget share for health in Bangladesh is the lowest in South Asia. The per capita health allocation in Bangladesh is $88 while that in Pakistan is $129, Nepal $137, Afghanistan $167, India $267, Bhutan $281, Sri Lanka $369 and the Maldives $1996.

In the outgoing 2019–20 fiscal year, the health allocation was 4.9 per cent of the total outlay and 0.89 per cent of the GDP, while the World Health Organisation recommends 15 per cent of the total outlay and 5 per cent of the GDP as the allocation for health.

The rate of health allocation in Bangladesh has rather been decreasing gradually, from 1.1 per cent of the GDP in 2010–11 to 0.89 in 2019–20 and from 6.2 per cent of the total outlay in 2010–11 to 4.9 per cent in 2019–20.

Rashid-e-Mahbub, a former pro vice-chancellor of Bangabandhu Sheikh Mujib Medical University, said that the general heath services were being widened in Bangladesh but the allocation remained below 1 per cent of the GDP, resulting in a mismatch between the expected services and the reality.

He viewed that a rapid hike in the allocation would not help either, rather a continuous increase with the target of raising the allocation, in the way the WHO recommended, over the next 15 years and building the capacity as to how to spend the budget could be a good approach.

‘At least we have to increase the allocation for health to two per cent of the GDP now,’ he said, stressing the need for emergency care.

‘We’ve to redesign our health system focusing on the emergency care and response mechanism from the villages to the districts to the capital,’ said Rashid, also a former president of Bangladesh Medical Association. 

Health economist professor Rumana Huque of Dhaka University said that alongside the increasing the allocation, proper planning, utilisation of the money and curbing corruption in the health sector are crucial.

‘The coronavirus pandemic has put us in a different reality and tells us not to be careless about the basic needs of health,’ she said.

Rumana said that the budget for the health sector in Bangladesh was not prepared based on the needs.

She said that a national needs assessment for the health sector was vital. She also emphasised gradual increases in the health sector allocation.

Dhaka University health economics professor Syed Abdul Hamid noted that the overall health department remained inefficient in making budget and in spending the allocated money.

‘The bureaucracy decides everything in the health ministry who rarely understand the health system or the health needs, but the health professionals like doctors who know about health are neither capable nor trained in how to make budget or how to spend it,’ he said.

‘The budget-makers and administrators should also be knowledgeable about the economy and health before just increasing the allocation,’ he went on.

Health ministry spokesperson and additional secretary Habibur Rahman Khan said that they had outlined a needs-based allocation proposal for health for the coming budget.

‘Arrangements for emergency care provisions like oxygen, ICUs, ventilators, laboratories, epidemiological assessments and proper screening and isolation mechanisms at the ports of entry will be prioritised in the coming budget,’ he said.