Rethinking the priorities of the health sector in a pandemic-responsive budget

The budget for the fiscal year 2021-2022 has been unveiled and Tk 32,731 crore or 5.42% of the total budget is allocated in the health sector. Due to the ongoing pandemic, a block allocation of Tk 10,000 crore has also been allocated to deal with the unanticipated emergency conditions of the Covid-19. Despite a significant increase in the health budget allocation, there are many questions around this new budget.

We talked to Dr MM Akash, Professor and Chairman of Economics department, Dhaka University, and Dr Rumana Huque and Dr Sayema Haque Bidisha, Professors of Economics, Dhaka University regarding the common queries of the budget of FY 2021-2022.

How the allocation can be utilised to reduce people's sufferings amid the pandemic

Historically, the budgetary allocation in the health sector is always low. During the Covid-19 pandemic, it should be utilised for both preventive and curative measures such as vaccination and mass awareness programs, developing physical infrastructure of hospitals and so on. "A dedicated portion of the health budget should be spent to improve the diagnostic system by building more diagnostic centres and increasing trained pathologists amid this pandemic. We should also spend on producing cheap Covid-19 testing kits so that people do not need to spend additional money for Covid-19 purposes," said Dr MM Akash. He added the importance of having a proper roadmap of the Covid-19 vaccination program, and a dedicated volunteer group that can help people with no or little access to modern technology to register for the vaccination program.

"Rather than setting up hospitals at random, the decision should be made after assessing the necessity and urgency of different areas. To fight against this pandemic, negotiation skills should be developed while buying vaccines and other necessities to have the appropriate deal. Moreover, the Covid-19 can accelerate antibiotic resistance soon. A block allocation of the health budget should be kept to deal with the upcoming health impacts due to this pandemic", replied Dr Rumana to the question about how to utilise this pandemic budget. "A person needs to bear around 70 per cent of his medical expenses on his own, and this pandemic has worsened this condition. Sufficient allocation is needed to support the health expenses of general people," said Dr Sayema. She has also mentioned the necessity of producing the Covid-19 vaccines domestically, which can minimise the medical expenses of individuals and fill up the shortage of vaccines within the country.

Non-Covid-19 health programmes need to be prioritised too

According to the health sector reform in 1998, 60-65% of total health expenditure should be on primary or preventive healthcare but the actual situation is not like that. It increases people's sufferings, as they now need to seek help in secondary and tertiary healthcare for those issues that can be prevented in primary healthcare. It shows the importance of implementing primary healthcare services efficiently. Furthermore, the Covid-19 pandemic has widened the gap in other non-Covid healthcare services and health-related programs such as vaccination programs for children and family planning programs. Dr Rumana mentioned that such non-Covid-19 health programs should be prioritised to avoid other health issues. She also said, "Appropriate attention and budgetary allocation should be given to autism, neurological disorder and other mental health-related issues. Ensuring quality services is also important for which paramedics and midwives need to be trained besides doctors and nurses."

"This pandemic has triggered unwanted pregnancies and unsafe childbirths as family planning programs have not been carried out properly in this pandemic year. Moreover, the non-Covid-19 patients with mild to severe diseases are struggling to have medical treatment due to the lack of attention on this non-Covid-19 side. No doubt that these should be prioritised too. A portion of this budgetary allocation should be used to expand hospitals and form separate wings for both the Covid-19 and non-Covid-19 patients to ensure safety for all," said Dr Sayema Bidisha. As per Professor Akash, non-Covid-19 issues are the results of the inefficiencies in implementation. They cannot be solved in just one budget, but these need to be taken care of too. While doing that, we have to eliminate corruption in the health sector without which broader allocation is of no use.

Need for health-related data for policy formulation

There is always a lack of real-time and authentic data in the health sector. Community-based health data and databases of patients are not always available making it hard to formulate appropriate policies. If we want to get rid of underreporting or overreporting of health-related cases, we need logistic support and also skilled people who can analyse the data and present it in an effective way to the policymakers as per Dr Rumana. This allocation may also be utilised to make such a database and train people in relevant fields. According to Dr Sayema, data collection, data availability and sex-disaggregated data are important to formulate policies in the health sector.

In addition, Professor MM Akash said, "Right to public health should be ensured and dispersed all over the country. The major approach of this year's budget is more towards livelihood, not towards lives, indicating that it was not a well-thought one amid the Covid-19 pandemic."