Key reasons why healthcare should be emphasised on the upcoming national budget
While Bangladesh’s successes in the health sector have been widely lauded at home and abroad, it is important to emphasise that as the country moves into a new league, health sector targets, as well as accompanying public investment plans and expenditures, must be evaluated and redesigned. Furthermore, the difficulties encountered during the ongoing COVID-19 outbreak have highlighted the flaws in our health-care system more than before. It is hardly surprising, however, because the sector is frequently overlooked in national budgetary allocations. Despite having one of the highest out-of-pocket health expenses in the area (74% of total health expenditure), Bangladesh’s health budget has been less than 1% of GDP for over a decade.
Our health-care system in Bangladesh has always had its limitations. With the arrival of COVID-19, however, everything became evident. We now understand how vulnerable we are to disasters. More resources are required, however increasing financial allocation alone will not fix the challenges. The fact that a quarter of the budget for the health sector goes unused every year contributes to the finance ministry’s decision not to increase the health budget’s portion.
It is undeniably true that Bangladesh has made significant progress in the health sector (particularly in the last 12 years or so), it is important to emphasise that the country lags significantly behind its South Asian rivals in terms of required public spending. Bangladesh’s overall investment in the health sector (public and private combined) is only 2.34% of GDP, although the ratio for South Asia as a whole is above 5% (more than double). Similarly, our per capita health expenditure (PPP, current USD) is USD 110, about four times greater than the rest of South Asia (USD 401). Despite this gap, government spending in this industry has remained relatively stable. While the Ministry of Health and Family Welfare’s (MoHFW) overall expenditure has climbed every year over the last decade, its share of total government expenditure has remained stable at roughly 5% as the size of our total GDP has expanded. More crucially, the MoHFW has failed to spend more than 28% of the money allotted to its development budget on average. This shows that there is still a lot of room for improvement in terms of budget implementation efficiency.
The government clearly needs to devote a larger portion of its upcoming national budget to the health sector. However, sensible selections must be taken to map the proper areas of investment (to channel the higher allocations to) in order to acquire more output for less money. In Bangladesh, for example, secondary healthcare receives the most government funding (39% of total public expenditure on health). Because tertiary healthcare receives the second greatest share (36%) of the budget, primary healthcare receives the least share (25%). Thousands more community clinics may be improved with the appropriate placement of doctors and technical support workers, as well as numerous testing facilities to boost primary healthcare spending. Additional funds could also be devoted toward improving primary healthcare facilities in metropolitan areas, where poor persons working in the informal sector have limited access. It is safe to conclude that the vast majority of persons seeking medical assistance in Bangladesh are still in primary care. As a result, authorities must consider how to ensure that this sub-sector receives a higher share of total health spending.
The geographic distribution of public health spending could also be improved. Significant spatial discrepancies have been discovered in public investment for district level government hospitals and Upazila health complexes.
When we look at the pattern of government spending on the health sector, we can see that the government planned on spending 13 to 21% of the total health budget on medical and surgical supplies’ last year. We know that this includes spending on delivering free and/or low-cost drugs to people seeking healthcare at government-run facilities. This means that as the share of medical and surgical supplies’ in overall health expenditure rises, people will have to pay less on medicine (meaning reduced out of pocket costs for health). This could be especially advantageous for low-income families. The geographic distribution of public health spending could also be improved. Significant spatial discrepancies have been discovered in public investment for district level government hospitals and Upazila health complexes. As a result, while raising health-care budgets, the government must ensure that a percentage of the new funds is used to correct discrepancies like these.
Attention to the health sector must go beyond simply boosting budgetary expenditures; it must also prioritise correcting systemic flaws. This involves an examination of the flaws (i.e., areas where there is significant scope of improvement). To this goal, statistics from around the country can be used. According to the 2016 Household Income and Expenditure Survey (HIES), just 15% of all healthcare seekers in urban areas originate from the poorest 20% of households. On the contrary, 28% of the population comes from the richest 20% of households.
This means that in metropolitan areas, households below the poverty line have much less access to government healthcare facilities. According to HIES 2016, 12% of diseased or injured people in Bangladesh do not seek any kind of formal healthcare. The percentage is predicted to be greater in hard-to-reach rural areas (17%), and even higher in urban areas (23 %). Only 17% of outpatients seek treatment at government-run clinics. The ratio is projected to be significantly greater for inpatients (57%). Furthermore, the statistics reveal that 43% of them rely on non-government facilities (meaning higher out-of-pocket expenses for them). As a result, we may use this information to identify the proper priorities when we plan to invest additional resources to increase access to healthcare.
To address regional inequities, increased outreach to lower-income strata, and increased coverage of government healthcare services, innovative pilot initiatives should be conducted as projects under the Annual Development Program. We must also begin working as quickly as feasible to create a universal health insurance system. Pilot projects, similar to the one currently underway in three Upazilas in Tangail District, should be performed in urban areas as well. They must eventually be scaled up and/or repeated, with the relevant lessons learned from the pilot experiments. Experts also advocate reconsidering the public service commission’s current health cadre. There have been recommendations that the cadre be divided into groups, with some allocated to health research/education, some to health administration, and yet others to frontline care providers. In fact, some of them believe that a separate service commission for health professionals should be established.
Prioritising non-COVID-19 health programs is also necessary. According to the health-care reform of 1998, primary and preventive care should account for 60-65% of total health spending, however this is not the case. It exacerbates people’s hardships by requiring them to seek help in secondary and tertiary healthcare for situations that may have been avoided with primary care. It emphasises the need of efficiently providing primary healthcare services. Furthermore, the pandemic has worsened the gap in non-COVID healthcare services and health-related activities, including childhood vaccinations and family planning. Non-COVID-19 health programs, according to a reputed expert, should be prioritised to avoid additional health difficulties. She also mentioned, “Autism, neurological disorders, and other mental health-related issues should be given adequate attention and budgetary allocation. Quality services must also be ensured, which necessitates the training of paramedics and midwives in addition to doctors and nurses.”
Health-related data is required for policy formulation. In the health sector, real-time and accurate data is always in short supply. Patients’ databases and community-based health data are not always available, making it difficult to design effective policies. According to a specialist, “If we want to eliminate underreporting or overreporting of health-related incidents, we need logistical support as well as skilled personnel who can analyse the data and communicate it to policymakers in an efficient manner.” He also mentioned that the upcoming budget might potentially be used to create a database and train people in related professions. Data collection, data availability, and sex-disaggregated data are all crucial in the health industry,
The right to public health should be guaranteed and widely distributed throughout the country. The main focus of this year’s budget should be on livelihood rather than lives, demonstrating that it was not well-considered in the midst of the Covid-19 outbreak. Furthermore, non-COVID-19 patients with mild to severe disorders are having difficulty receiving medical treatment due to the non-COVID-19 side’s lack of attention. These, without a doubt, should be prioritised as well. To ensure everyone’s safety, a portion of this budgetary allocation should be spent to enlarge hospitals and create separate wings for both COVID-19 and non-COVID-19 patients,” stated a health practitioner. Non-COVID-19 difficulties, according to Professor Akash, are the result of implementation inefficiencies.
We need to devote more funds from our health budget to widely disseminating mental health care. With COVID-19 greatly influencing us, mental health difficulties became more acute, with lost lives, widespread job losses, lower income, delayed education, and so on. As a result, it is past time for us to start paying attention to this area by strengthening human and physical resources as well as raising public awareness.