All eyes were on how Finance Minister AHM Mustafa Kamal would plan to revamp the country's ill-equipped and Covid-battered health sector when he presented the 50th budget yesterday.

Although Kamal in his budget speech said the health sector was the top priority, experts termed it frustrating.

The health budget for the 2021-2022 fiscal year offers nothing new compared to the last one. The finance minister earmarked around Tk 32,731 crore or 5.42 percent of the total budget or only 0.95 percent of GDP.

In the outgoing fiscal year, the government allocated Tk 29,247 crore or 5.15 percent of the total budget and 5.84 percent of the revised budget.

Public spending on healthcare has been hovering below 1 percent of the GDP for the last twelve fiscals, although the World Health Organisation recommends it to be 5 percent of GDP.

According to the Eight Fiscal Year Plan of 2021-2025, the government target is to spend 2 percent.

Besides, a block allocation of Tk 10,000 crore has been kept to meet the expenses related to unanticipated emergency requirements, like in the previous fiscal.

Health experts and right activists said a considerable increase in budgetary allocation focusing on primary healthcare would have been a true recognition from the government for the health sector, which is battling against the pandemic to save life and livelihood.

Although there is no mention of separate allocation for Covid-19 vaccines, the minister only said the government would provide "as much funds as is required" for procuring the required doses.

"During the critical period of the pandemic, the government has strengthened its efforts to ensure affordable health services for all citizens through the development of the health, nutrition and population sector," the finance minister said in his budget speech.

He also said there is a plan to vaccinate 80 percent of the population in phases -- 25 lakh each month.

The government had earlier planned to vaccinate 50 lakh a month. But the vaccination campaign fell into uncertainty due the dearth of vaccine supply.

His statement also did not reflect the implementation plan, especially how effectively the money allocated for the health sector will be spent, experts said.

For instance, 24 percent of the development budget for the health sector remained unused while the health service division only spent 25.46 percent of its allocation budget in the first ten months of FY 2020-21.

Most of the block allocation of Tk 10,000 crore in a previous fiscal is also unspent.

Despite an increase in the annual development programme (ADP) allocation during Covid-19 pandemic, the health sector failed to spend 71 percent of the funds for health in the first ten months of fiscal 2020-2021, according to the Implementation Monitoring and Evaluation Division (IMED).

Experts also observed some key issues were unaddressed -- like accelerating budget execution and release of funds to frontline services; ensuring rapid access to Covid-19 services for all those who need it; strengthening the core of the health system even as the immediate response takes priority, health security and universal health coverage (UHC).

However, in a positive move, the minister proposed tax exemption to general hospitals with a minimum of 250-bed capacity and also to specialised hospitals established in districts other than Dhaka, Narayanganj, Gazipur, and Chattogram.

Like the previous fiscal year, he also proposed allocation of Tk 100-crore Integrated Health-Science Research and Development Fund to finance the activities for the development of research on health education, and science and technology.

Of the overall health budget, 52.5 percent comprised operating costs while the rest has been allocated for development.

NOT FIT FOR PANDEMIC

Looking deep into the breakdown figures, it can be said that the government's health budget is not fit for the pandemic with no exception from the previous fiscals.

Dr Rashid-E-Mahbub, president of Bangladesh Health Rights Movement, told The Daily Star, "The budget proposal for health is unacceptable. There are some allocations for oxygen and ICU. But the health sector needs a reformation putting primary healthcare in the heart. There is no mention of it in the budget."

While the Covid-19 has claimed around 12,724 lives and infected 8,05,980 people as of yesterday, there is no sign the pandemic will end in the near future.

With a far reaching goal to vaccinate 80 percent of the population, the issue of Covid-19 transmission control as an immediate task is of paramount importance.

However, the finance minister in his speech only focused on testing capacity, oxygen supply and ICU and screening and isolation centre. He has not said anything about community mobilisation.

Besides, the healthcare allocation is far from what is necessary to ensure quality healthcare service for all irrespective of income and region, which has become even more important during the Covid-19 pandemic.

Every year, 7 percent of households in Bangladesh are pushed into poverty as a result of out-of-pocket spending on health, according to the 2019 joint report by the World Health Organisation and the World Bank.

The out-of-pocket spending on health is very high in Bangladesh, around 73.87 percent -- the highest among the South Asian countries after Afghanistan's 78.38 percent.

While all the South Asian countries spend $401 per capita as health expenditure, Bangladesh spends the lowest -- only $110.

"Look at the shares of different sectors in the total budget. It has been proved once again that the health sector is not a priority of the government. The government does not mean what it says," Dr Muhammod Abdus Sabur, adjunct professor at the Institute of Health Economics (IHE) of the University of Dhaka told The Daily Star.

He said the absorption capacity of the health sector is a "vague issue".

Dr Shafiun Shimul, associate professor of the IHE at DU said, "Since it is a huge deficit budget, ensuring the fund for the allocated budget for health could also be a challenge. Besides, the block allocation will be less effective due to procedural issues on spending.

"Increasing the capacity to Covid-19 tests, screening, isolation centres and setting up Covid-19 hospitals are not the only ways to control pandemic. The main challenge in controlling the pandemic is successful risk communication and community mobilisation. But there is no clear mention in this regard."