Meagre health budget stymies fight against high blood pressure

Spending Tk 1 per person more in annual health budget can slash risks 18-fold

Doulot Akter Mala | Published: December 25, 2023 22:34:24

Nilufa Yasmin, a pseudonym, began taking medication for high blood pressure prescribed by her upazila health complex doctor six months ago.
However, in August this year, she could no longer find her free medication at the community clinic in her
neighbourhood or at the health complex pharmacy in Sylhet's Golapganj -- a more than six-hour drive from Dhaka.
For middle-aged and poor women like Nilufa, public health facilities running out of essential medication is a serious concern.
"It's still okay if you miss one of your daily meals. But skipping even a single dose of blood pressure medication could have fatal consequences like stroke or heart attack," she recalled what her doctor said about daily medication.
But what could poor Nilufa do except ignore it all?
Anjoli Rani Talukder, a local community health care provider, said that like Nilufa, the medicine shortage in August left many low-income hypertension patients in Golapganj's Baushi village with no choice but to stop taking their medication.
Three months after the initial field visit, this correspondent on Thursday last week contacted Ms Talukder to follow up on the situation. Unfortunately, she confirmed that the situation has not improved much.
While a small quantity of hypertension medication (around 500 tablets) was provided in instalments, it falls far short of the needs.
"Many patients who started taking medication for high blood pressure have now stopped due to the lack of availability at both the community clinic and the upazila hospital," Ms Talukder added.
Scant health budget gets in the way of SDG efforts
A meagre health budget in Bangladesh is hindering efforts to achieve a key Sustainable Development Goal (SDG): reducing deaths from non-communicable diseases (NCDs) by one-third by 2030.
The issue is particularly pressing considering the nation's widespread NCD burden. A recent national survey showed that one in four adults in the country suffers from hypertension.
Public health experts warn that the insufficient budget allocation for the health sector, including essential needs assessments, disrupts crucial drug supplies like hypertension medication.
In line with the SDG goals and to improve public healthcare access, the government in May this year launched a free-drugs initiative, providing Amlodipine 5.0mg and Metformin 500mg, for high blood pressure and diabetes respectively, at community clinics.
However, this initiative remains vulnerable to funding constraints.
Unless free hypertension drugs are consistently available, low-income groups often skip medication due to cost or lack of awareness, according to Dr Robed Amin, director of the Non-Communicable Disease Control Programme under the Directorate General of Health Services.
Limited budget for needs assessments at the grassroots level further exacerbates the supply chain disruptions, Dr Amin added.
He said the current initiative for the two free medicines operates on a "no-cost extension", despite a funding request of Tk 300 million already submitted.
As a solution, the government has authorised community clinics to buy hypertension and diabetes medication on their own, he said.
"We anticipate a smoother supply of hypertension drugs once the government allocates a budget for procurement in the next fiscal year," Dr Amin added.
Tk1 per person more spending can slash high BP risks by 18 times
Bangladesh faces a significant burden of high blood pressure, with a disproportionate impact on lower and middle-income communities. International surveys and reports link this partly to the nation's meagre Tk 6.8 per capita budget for non-communicable diseases (NCDs).
Hope emerges from a recent study suggesting that by simply increasing the national health budget by Tk1 per capita, Bangladesh could reduce the growing prevalence of hypertension by a whopping 18 times.
On Bangladesh's public health spending shortfall, a World Bank report ranks the country 184th out of 186 countries in terms of government health expenditure as a percentage of GDP.
Dr Robed Amin said the government has allocated Tk 1 billion for hypertension medication for 250,000 registered patients. However, the monthly demand for these drugs stands at Tk 120 million, highlighting the funding gap.
On a positive note, the top health directorate official said NCD corners are being established in upzila health centres across the country, currently reaching 340 and expanding fast.
A first-ever World Health Organization (WHO) report on NCDs released in September 2023 showed that 78 per cent of hypertension patients reside in lower and middle-income countries, with 36 per cent unaware of their condition.
Of them, some 62 per cent are male and the rest are female -- who are being deprived of necessary health care services.
The situation in Bangladesh mirrors these global trends.
The WHO report found that only 38 per cent of high blood pressure patients receive treatment, and just 15 per cent manage their condition effectively.
This is despite treatment availability in seven out of ten upazila health centres. However, challenges remain as healthcare centres often lack trained personnel (29 per cent deficit) and clear guidelines for hypertension detection and management (17 per cent deficit).
Adding to the complexity, many patients hesitate to take regular medication due to the asymptomatic nature of high blood pressure.
World Bank findings highlight the inadequacy of Bangladesh's dedicated NCD control budget, representing only 4.2 per cent of the health sector programme or Tk 6.8 per capita. Besides, Bangladesh's overall health budget allocation is among the lowest in the region, averaging 0.71 per cent from FY16 to FY24.
A glimmer of hope appeared in a recent research conducted jointly by BRAC and the Copenhagen Consensus Center. The study suggests that increasing the health budget by just Tk1 could dramatically reduce hypertension prevalence.
This study also pinpointed cost-effective solutions like improving hypertension management and tackling tobacco use.
Free drugs praiseworthy, but supply streamlining needed
Treating high blood pressure is manageable and relatively inexpensive, costing around Tk 7,000 per person annually for screenings and medication like aspirin.
While initiatives like distributing free drugs through community clinics have been lauded, ensuring consistent supply appears to be challenging.
Muhammad Ruhul Quddus, Bangladesh Country Lead for the Global Health Advocacy Incubator (GHAI), admitted that it would take time to streamline the drug supply up to the grassroots.
He said that the May decision to offer free medication at clinics didn't allow for immediate budget adjustments for drug procurement. However, there are reasons to be optimistic for a streamlined process in the next fiscal year.
ABM Zubair, chief of PROGGA (Knowledge for Progress), an advocacy organisation tackling hypertension, praised the initiative but called for maintaining an uninterrupted drug supply throughout the country.
"Sustaining this positive impact requires consistent availability of these medicines across the country," commented Mr Zubair.
He also suggests prescribing two to three months' worth of medication at a time, alongside ensuring community clinic stocks, to save lives and prevent heart attacks and strokes at minimal cost.
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