Bangladesh's health sector receives approximately 5% of the total national budget. This amount is very inadequate as the World Health Organisation recommends allocating at least 15% of the total budget for health.
But, the problem is that the Ministry of Health cannot spend even that allocation fully.
An analysis of the last 10-15 years' data shows that although 95%-98% of the operating budget is spent every year, over 25% of the development segment remains unused. The development budget is not used rationally for various reasons, including a lack of efficiency in procurement, bureaucratic complexities, and delayed release of funds.
We need to form a strong task force for the development of the health sector. The task force will identify and resolve the issues prevailing in the sector.
The Covid pandemic is likely to end soon, but many more epidemics may come in the days ahead, putting us in danger. If the healthcare sector in the country does not improve, the tendency of people to go abroad for treatment will increase and the pressure on the dollar will increase.
A large part of the development budget is spent on procurement. Those who are involved in spending money in this area lack procurement-related skills. Generally, physicians are less interested in accounting, economics, and finance. Even though doctors who are assigned to perform these tasks are now given some relevant training, it is scanty.
Besides, any procurement requires permission from various authorities at various stages. Therefore, power needs to be decentralised to ease budget implementation.
Purchases can be made on time if funds are disbursed at the beginning of the fiscal year. It is necessary to build a central entity to conduct all procurement activities. Post-purchase corruption related to audits and accounts should be stopped. Files should be digitised and file disposal time should be fixed at 3-5 days. Officers should be provided with sufficient training in economics, finance, and accounting. And for long-term health managers, separate positions need to be created in the Bangladesh Civil Service (BCS). Those who will be appointed to managerial positions in the health sector should do those jobs from the beginning. They will never work as clinicians.
The Covid-19 pandemic has shown us that our healthcare sector has many shortcomings. To address those limitations, the budget allocation has to be increased. Preventive care is missing in our country. This should be given importance. Infrastructure should be developed, and necessary manpower should be recruited.
The health sector now has a huge shortage of professionals including cleaners, nurses, and technicians. These posts have remained vacant year after year. More budget is needed to appoint people to these posts. But, we must keep in mind that health is not like other sectors. This is a technical sector.
A policeman or a teacher can serve 50 people. But, in the health sector, a team of doctors, nurses, technicians, and ward boys is required to render service to a single patient. Most of our 50-bed hospitals are being run with manpower recruited to run a 30-bed hospital. These problems must be resolved. Required manpower should be recruited at hospitals after revising the organograms.
Our hospitals do not provide adequate free medicines. The dispensaries for keeping medicines are substandard.
The health sector needs to be people-friendly. We have hospitals and other infrastructures, but they are not ready to provide quality services. To address these shortcomings, the government has to increase budget allocation to the health sector. And to make sure the allocation is fully utilised, necessary steps need to be taken to train the officials concerned and create a conducive environment.