Increased budget must come with policy changes, utilisation

The budget allocation in health and family welfare has seen a steady increase in the past few years. This year, the amount increased by 13.66 percent, standing at Tk 29,247 crore.

Although the increased allocation appears to be a step in the right direction, family planning experts believe that the higher budgets are not being utilised in a planned manner.

Meanwhile, the pandemic has created new problems in family planning, hence this budget is inadequate amid the public health crisis, opined experts.

Pulak Raha is a team leader at Advance Family Planning, an initiative working to reach the global goal of expanding access to quality contraceptive information, services and supplies. He said that increased budget allocation should be supplemented with changes in policy if the government wants to meet its targets within 2022.

"The government is targeting to reduce the current stagnant total fertility rate (TFR) from 2.3 to 2; reach a contraceptive prevalence rate (CPR) of 75 percent from the current 62 percent; reduce the unmet need for family planning services, and enable more men to use modern contraception, as the ratio of CPR among women and men is still 6:1," said Pulak.

Moreover, family planning services have been disrupted due to the pandemic. Cumulative data from January to May 2020 compared with the same period of 2019 shows that uptake of oral contraceptive pill decreased by 20 percent, condom use by 34 percent and injectables by 23 percent, according to United Nations Populations Fund (UNFPA).

"As you can see, there is already an increase in the number of unintended pregnancies and unsafe abortion. These issues should have been reflected in the newly proposed budget allocation," opined Pulak.

Besides, the government must ensure protective gears for the field workers working in rural areas, so that they can continue to provide uninterrupted family planning service during this pandemic, he added.

SM Shaikat, the executive director of SERAC-Bangladesh, a youth focused rights and development organisation, pointed out the flaws in prioritisation. "Yes, there is an increase in allocation but if you look closely, most projects will invest more in infrastructure and neglect family planning and reproductive health section."

"Family planning, contraception, and reproductive health have played a vital role in reducing the country's maternal mortality rate, and this has significantly impacted the health of the younger generation and adolescents, who make up about one-third of the total population of Bangladesh," he said.

Although Directorate General of Family Planning (DGFP) on its running operational plan put adolescent and maternal health operational plan third in line in course of budget allocation (3.14 percent out of 11.32 percent) in the programme implementation plan, Shaikat, however, urges that the DGFP should create a separate budget line and operational plan for adolescent health to meet the indicators set in the National Adolescent Health Strategy and work plan.

On the other hand, Masrurul Islam, country director of Marie Stopes Bangladesh believes that instead of spending the budget hurriedly in the last moment of the fiscal year, the issue of re-adjusting the budget should be considered and there must proper monitoring from the beginning of the fiscal year.

"Marie Stopes Bangladesh has been providing technical assistance to DGFP in this regard and will continue to do so in the future. In addition to that, public-private partnerships need to be further strengthened by ensuring the participation of NGOs in government programmes, promotion and service expansion, and improving the quality of health and family planning services by ensuring public and private service policies," he said.

Dr Md Sarwar Bari, director (finance) at DGFP, however, said the directorate is satisfied with this year's budget and he's hopeful that they will be able to cover their yearly activities with this increase. Besides, DGFP is also hopeful to fulfill every target by 2022.

In addition to that, DGFP has been bringing some changes in their priorities due to the coronavirus outbreak. "For example, this time, we are giving more attention to infection control, so that our field workers remain safe. There was a service disruption during March-April as our field workers were scared to provide services. From this month, everything is getting normal. Most of them got their personal protection equipment and are now providing their services without any major interruption," he said.

At the same time, DGFP is also bringing some changes in their activities. Since the family planning staffers are providing their services three days a week, for the rest of the working days, they are giving their products to health staffers so that people can still have access to contraceptives.