The Ministry of Health and Family Welfare has drafted the fifth phase of the Health, Population and Nutrition Sector Programme (5th HPNSP) at an estimated cost of over Tk1.06 trillion, aiming the highest attainable level of health for all.
The government will provide Tk 806.85 billion from its exchequer, and another Tk 254.15 billion, around 23.95 per cent of the total cost, will be mobilised from foreign sources as loans and grants.
The health ministry sent the proposal in this regard to the planning ministry, said high officials of both the ministries.
The health ministry completed implementation of the 4th HPNSP in last June spending Tk493.75 billion, of which Tk304.66 billion came from the government fund and Tk189.08 billion from foreign assistance.
The health sector development expenditure is set to increase by 114.89 per cent for the next programme, but the foreign assistance to increase by a moderate lower rate of 34.41 per cent.
The share of foreign assistance in the fifth programme dropped to 23.95 per cent in the proposed programme from 38.30 per cent of the 4th programme.
It is also reported that the sources of $770 million foreign aid included in the project cost are yet to be identified.
A series of meeting are being conducted for the last one month by the Socio Economic Infrastructure Division of the Planning Commission to evaluate the 38 operational plans (OPs) of the proposed programme, confirmed Rehana Perven, member (Secretary) of the division.
"Usually a one-day meeting of project evaluation committee (PEC) is sufficient to evaluate a project, but such larger programmes take more than a month to evaluate, Rehana Perven told The Financial Express.
Details of each operational plan of the programme proposed by the health ministry are being discussed separately in the meeting, she added.
Experts in the health sector and economists underlined setting a mechanism to ensure quality health expenditure prior to approval of a new sector programme.
They also expressed concern over reducing share of development from sources abroad at a time when the government is facing financial crunch due to reducing revenue generation.
"Release of funds to meet emergency spending like community clinics, union health centre, procurement of vaccines remained suspended since last July after completion of the latest health sector programme," said Dr Syed Abdul Hamid, professor at the Institute of Health Economics of Dhaka University.
He said that the spending for important components of the health sector should be paid immediately prior to approval of projects or programme.
The health economists also said that the government health allocation remained stalled at a certain level for a decade and it should be increased.
Quality spending is more important than the increase in allocation, he explained further.
The officials said that he health service division will implement a sum of 23 operational plans (OP) with a combined cost of Tk664.92 billion, while the medical education and family welfare division would implement another 15 OPs at an estimated cost of around Tk396.08 billion.
All of the organisations under both divisions will jointly implement the programme, but the health service division would be solely responsible at the approval and revision stage.
Officials of the health ministry said that the overall development activities of the health and family welfare ministry have been under a single programme since 1998. The first phase of the programme was implemented during the period of 1998-2003 integrating around 126 projects.
The fourth phase of the programme was implemented from January 2017 to June 2024 and the health ministry initiated formulating the 5th phase of programme in 2022 to be implemented up to June 2029.
Officials said that a sum of $2.31 billion or Tk254.15 billion has been estimated as development assistance from foreign sources. Whatever the ministry secured commitment of foreign aid worth $1.59 billion, $1.06 billion as loans and $529.54 million as grants.
The World Bank consented to provide loan worth $479 million, while the Asian Development Bank (ADB) will provide $500 million.
Three countries and eight multilateral development partners including the Japan International Cooperation Agency (Jica), the Global Financial Facility (GFF), Global Fund, Sweden, Canada, UNICEF, Gavi, UNFPA and the World Health Organization will provide aid for the programme.
The process of approval of the programme was initiated with a shortage of Tk77 billion or $700 million, said officials of the health ministry.
They said that there is no specific commitment from development partner but has some indications to manage remaining $700 million.
The health ministry seeks provision of 1,48,332 manpower to implement the programme but the finance division revised downed the number to 45,073, revealed the proposal.
Out of the recommended manpower, 19,492 are proposed to carry over from the 4th sector programme and another 25,581 posts are proposed for fresh recruitment.
Reducing the proportion of foreign aid for health is disappointing, said Dr Fahmida Khatun, executive director at the Center for Policy Dialogue (CPD).
She said the flow of foreign grants and concessional loans has reduced since upgrading to lower middle-income country (LMIC) from low-income countries (LIC) and such support will reduce farther after graduating from the least developed countries (LDCs).
The economist urged the government to increase allocation from the domestic sources to meet the rising demand of health services, development of health related soft infrastructure and ensure skilled human resources.
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