Calls pour in to increase budget for the health sector but the health ministry, despite being a top recipient of the government's development expenditure, could not even reach the national average of ADP implementation rate in the last six years.

As a result, the allocation to the sector go down in the revised Annual Development Programme (ADP) every year. Still, the ministry fails to meet its expenditure target.

Experts see a lack of capacity to run projects as planned, skilled manpower and corruption as other reasons behind the situation. They said the health sector was already in a fragile state with systemic weaknesses and the Covid-19 pandemic only exposed it.

Until the fiscal 2016-17, Annual Development Programme (ADP) was allocated to the Health and Family Welfare Ministry as one unit. After that, the development fund has been allocated separately to two divisions of the ministry -- Health Service Division (HSD) and Medical Education and Family Welfare Division.

The HSD was the seventh highest ADP recipient among all ministries and divisions in the last fiscal year, but it was a low performer among 15 top ADP-recipient ministries and divisions, show relevant documents.

When the average ADP implementation rate was 80.45 percent in the just-concluded fiscal year, the progress of HSD was only 73.96 percent. For the Medical Education and Family Welfare Division, it was 64.19 percent.

Of the 15 ministries and divisions, three ministries -- Railways (57.39 percent), Primary and Mass Education (71.89 percent) and Housing and Public Works (70.51 percent) -- performed even more poorly, show ADP documents.

SLOW IMPLEMENTATION

There have been several examples of the health ministry going slow with ADP implementation in projects.

The 4th Health, Population and Nutrition Sector Development Programme under the HSD could be a case in point.

Funded by donor agencies, Directorate General of Health Services (DGHS) is implementing the Tk 36,220 crore project, supposed to run from January 2017 until June 2022. It has 29 components for developing the health sector and making it more efficient.

Till February this year, the project authorities, however, could spend Tk 13,314 crore, although more than two-third of the project tenure is already gone.

In the revised ADP for the last fiscal year, the project got Tk 7,736 crore, but the project authorities could spend only Tk 2,247 crore till February. Then Covid-19 hit the country, which slowed down almost all the development projects.

In another project, the DGHS started building the National Institute of Laboratory Medicine and Referral Centre (NILMRC) at Sher-E-Bangla Nagar in the capital in July 2010, with the deadline June 2013.

The aim of the project was to facilitate manpower training in laboratory medicine at hospital and community levels; establishing a network among diagnostic laboratories across the country; set up a reference centre for pathology services; provide accreditation for diagnostic labs; offer post-graduate courses and research; and earn revenue.

Ten years have gone by, but the project is yet to be completed.

The deadline was extended for the fifth time in October last year. The initial cost of the project was estimated at Tk 138.14 crore, which has been increased by 41 percent to Tk 194.32 crore, with the last deadline expiring in June this year.

A total of Tk 96 crore has been spent till February this year. In the revised ADP for the last fiscal year, the project got Tk 85 crore, but only Tk 72 lakh could be spent till February, show ADP documents.

The Daily Star tried to reach Health Services Division Secretary Abdul Mannan over phone for comments on the ADP implementation rate in the sector, but he did not receive the call.

VICIOUS CYCLE OF UNDERFUNDING

& UNDERUTILISATION

Zahid Hussain, former lead economist of the World Bank's Dhaka office, said the underperformance of the health sector in budget implementation year after year explains why the health system was so ill-equipped to face the Covid-19 pandemic.

"The infrastructure and human capital deficiencies in health were known long before this pandemic. Yet the sector remained stuck in a vicious cycle of underfunding and underutilisation of funds," he told The Daily Star yesterday.

The Covid-19 also unraveled the endemic governance problems in the sector, which suggest that even the money that was spent did not bring much value, he said. "We cannot get out of this vicious cycle of underfunding and underutilisation if we do not recognise the gravity of the problem." 

The economist said investments in health capacity building would not pay off if public health policies were not based on scientific principles, and the conduct of the business of public health was not liberated from corruption.

"Corruption is the deepest cause of the government and market failures in the provision of health services," he added.

Prof Dr Muzaherul Huq, former regional adviser, WHO, South East Asia Region, said there was a lack of health management skill and skilled manpower -- both at the health ministry and the DGHS -- to properly utilise allocated money for the sector.

"Besides, there is a lack of proper strategic planning. But whatever planning is done, the implementation [of those plans] is not properly monitored and supervised. People are not getting benefit of whatever budget is allocated," he told The Daily Star yesterday.

Besides, the sector is riddled with rampant corruption and misuse of assets in infrastructure development and procurement of medical equipment and accessories, said Muzaherul, adding, "A proper plan on procurement after assessing the need and requirement is absent. So people are not enjoying benefits even after a huge amount of money is spent."