So, it is common for people who are well-off - many politicians among them - to routinely go abroad seeking healthcare services. This indicates that there is no confidence in the health services here. And it is a drain on the valuable foreign currency reserves.
While a lack of good governance and corruption that continuously proves cancerous to the healthcare sector, are mainly responsible for the deteriorating condition, low per capita expenditure on health is also a chronic problem. Bangladesh ranks lowest among South Asian countries in terms of per capita expenditure on health. The per capita health expenditure in Bangladesh is just $45, compared to $58 in Nepal, $73 in India, $103 in Bhutan, and $157 in Sri Lanka. This appalling expenditure results in inadequate healthcare infrastructure, insufficient medical supplies, a shortage of trained medical professionals in rural areas and exorbitantly high medical expenses borne by patients themselves, which many can ill afford.
According to a World Bank study, out-of-pocket spending (OOPS) of households in Bangladesh accounts for a whopping 73.9 per cent of health expenditure. By comparison, the OOPS percentages are 58 per cent in Nepal, 55 per cent in India, 54 per cent in Pakistan, 46 per cent in Sri Lanka, and 18 per cent in Bhutan. The higher the OOPS percentage rate, greater is the burden on people to spend on healthcare services from their own pockets. Bangladeshi families are forced into making difficult choices. Many of them either forego treatment, have to borrow money, or sell livestock or their properties, to afford treatment for critically ill patients. The government's eighth five-year plan also recognises that escalating OOPS poses a threat to national poverty reduction efforts and calls for an increase in health financing.
Against this backdrop, the proposed national budget for the 2024-25 fiscal year allocates Tk 414.08 billion for the health sector, representing 5.19 per cent of the total proposed national budget. This allocation marks a slight increase from Tk 380.52 billion in the outgoing FY2023-24. However, if the current higher rate of inflation is factored in, the size of the proposed healthcare budget has actually shrunk. This raises concerns about the further rise in out-of-pocket expenditure.
The World Health Organization recommends allocation of at least 15 per cent of total budget for the health sector, but Bangladesh allocates only around 5 per cent. The country's health budgetary support is one of the lowest in the WHO South-East Asia region. Public health experts have been urging the government to increase the health sector's budget allocation to address outbreaks of various vector-borne and communicable diseases, as well as the alarming rise in deaths from non-communicable diseases. But allocation for health sector has remained stuck at around five per cent of the fiscal outlay for the last two decades.
To make matters worse, the Ministry of Health and Family Welfare struggles to fully utilise a significant portion of the development fund. For instance, in the outgoing fiscal year, the ministry failed to spend Tk 82.69 billion out of the total allocation, purportedly due to a lack of budget implementation capacity and delays in completing development projects. Consequently, the unspent funds were returned. Many sensibly argue that increasing the allocation without actually enhancing project implementation capacity is pointless. So, enhancing budget implementation capacity would not only improve healthcare delivery, but also justify higher budgetary allocations in the future.
Some positive aspects of the health budget include the allocation of Tk 2 billion to address emergency health risks and Tk 100 million for research purposes. Concessions have also been granted on kidney dialysis filters and dengue kits, which are steps in the right direction. However, there is a downside as the duty on medical equipment has been increased from 1 per cent to 10 per cent, which doesn't make sense, considering the fact that health sector needs help, not hindrance.
That said, the finance minister presented a long list of what the government has done and proposes to do, including ongoing efforts to ensure universal health and nutrition, achieving Sustainable Development Goals by 2030, developing scientific research in various disciplines of health sciences and expansion of infrastructural facilities for the improvement of the public health sector. But, in sharp contrast to these efforts, news reports frequently portray a sorry picture of medical services at various government hospitals where some valuable pieces of medical equipment are lying completely idle and inoperative for lack of timely repair or replacement and are falling into irreversible decay. This compels patients to seek services at private clinics at a high cost.
The sorrowful situation is further aggravated due to the reluctance of a large section of medical professionals to deliver sincere service, especially in rural areas. The government made a three-year stint at upazila level mandatory for newly recruited doctors, but reports suggest that most of them lobby for getting transferred to city areas within three/four months of getting appointed at rural areas. Thus, in the absence of doctors, people are not receiving the intended benefit from the government's vast network of upazila health complexes and community clinics throughout the country. Moreover, facilities in these hospitals like free medicine are scarce allegedly because of pilferage. These are some the ailments eating into the vitals of the health sector. So, while thinking big, the authorities should also not forget to pay attention to smaller things to ensure a steady flow of medical services to the people. Everyone knows how a small single Aspirin can bring comfort to those with a throbbing headache.
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