Health sector reformation and challenges of implementation

The cabinet division of the Government of Bangladesh has bifurcated the Ministry of Health and Family Welfare into two separate divisions, namely Health Services Division and Medical Education and Family Welfare Division through a gazette notification on March 16, 2017.

This is not the first attempt towards reformation to ensure better governance and effective implementation of the health sector programme. Health Ministry was functional as Health Division and Family Planning and Population Control Division in late 1970. Later in 1985, the Government decided to merge both divisions into one ministry to bring all health and family planning activities under a unified command with a view to ensuring effective coordination and monitoring of services, efficient management of logistics and supplies and to ensure adequate mobilisation of human resources etc.

This concept of unified and coordinated management information system has later on, developed into a sector wide approach in 1998 that led to adopt the Health Population and Nutrition Sector Programme (HPNSP) integrating the activities of Health and Family Planning from Upazilla to below under the supervision of the Upazilla Health and Family Planning Officer.

The Executive Committee Of National Economic Council (ECNEC) has approved the 4th HPNSP on 21st March, 2017 with the financial outlay of taka 1 lakh 15 thousands and 548 crores mega health project for the period of 2017-2022. This is for the first time the investment of the Government is around 84% where development partners' contribution is only taka 18 thousands and 847 crores.

This size of the HPNSP is higher by almost 126% than the 3rd HPNSP of 2011-2016 where it was only taka 51 thousands and 84 crores project. This time the services delivery system has been diversified with the emphasis on non-communicable diseases like cancer, cardio-vascular diseases, diabetes and intestinal disorders etc. to address as integrated approach.

Increasing the size of the project with mobilisation of resources and recruitment of huge manpower does not indicate an efficient and appropriate strategic measure to achieve the 'Universal Health Care' or attain the object of 'Health for all' by reaching the sustainability goal of 'ensure healthy lives and promote well-being for all at all ages' as envisaged in the Sustainable Development Goals (SDG) by 2030.

Public at present spend about 65% health expenditure out of their own pocket whereas the Health Ministry could not spend the earmarked budget of 3rd HPNSP within July 2016 and the project had to be extended by six months on no cost basis up to December 2016. The patients are to buy drugs and medicines almost 90% from drug stores and 50% of which based on advices over the counter without prescription.

The people at large expect health care delivery system must be transparent and accountable with high standard of integrity supported by strong vigilance and monitoring with an effective network of surveillance. There must be alternate source of financing like health insurance to overcome the risk of coverage from costly treatment of cancer, cardiovascular diseases, renal failure etc.

The vision of the health care reformation is to ensure access to affordable health care in comfortable friendly services providing facilities. The health care reform is meant to broaden the population that receives treatment and care coverage with quality and decreasing the cost of the care. If this objective is not targeted properly and measures not taken prudently, the bifurcation of the Ministry of Health and Family Welfare or increasing the outlay of the Sector Programme will remain a far cry to archive its targets.

The writer is a former advisor to the caretaker government.

E-mail: dknath888@gmail.com