The Ministry of Health and Family Welfare has decided not to move forward with the fifth phase of the Health, Population, and Nutrition Sector Programme (5th HPNSP) to avoid financial mismanagement and redundancy.
The decision came from a series of seven high-level meetings held recently and chaired by Prof Dr Md Sayedur Rahman, special assistant to the chief adviser appointed to the health ministry, reveals an official letter sent to various ministries, divisions, and government agencies.
The programme was proposed with an estimated cost of Tk 1.06 trillion to support health sector development activities over the next five years.
Sources confirmed that the government planned to allocate Tk 806.85 billion from its own resources, while Tk 254.15 billion was expected to be secured from foreign loans and grants.
Discarding the proposal will mark the end of the sector programme for the development and management of health services, which has been in place for the past 27 years, and will pave the way for going back to a project-based development system similar to other sectors.
The meetings also decided to fast-track the formulation and approval of three new projects to maintain essential health services delivery for the next two years and complete the key unfinished tasks of the fourth programme, which ended in June last year, to cover the gap created by the scrapping of the new one.
Sources said the government launched the Health and Population Sector Programme (HPSP) in 1998 by consolidating 126 projects under the health ministry to enhance coordination in health sector development and streamline access to sector-based loans and grants from development partners.
After the first programme's completion in 2003, the second programme (HNPSP) was implemented from 2003 to 2011, followed by the third (HPNSDP) from 2011 to 2016.
The fourth programme (4th HPNSP), originally planned for January 2017 to June 2022, was later extended until June 2024 and has now concluded.
To maintain continuity, the Health Services Division under the health ministry started formulating the fifth phase in mid-2022 and forwarded the proposal in May last year to the planning commission.
The Socio-Economic Infrastructure Division of the commission held 60 project evaluation committee (PEC) meetings over three months to assess 38 operational plans under the programme.
Following the assessments, the commission sent back the proposal with numerous recommendations, including the formulation of an exit plan after implementation.
However, with the exit plan finalised even before the programme's approval, the country's health service development management has reverted to its pre-1998 state - operating on an individual project basis.
In the late 1990s, Bangladesh embarked on a sector-based development approach with the launch of the first Primary Education Development Programme (PEDP-1).
Building on this donor-recommended foundation, ministries introduced programmes in the secondary education, higher education, and health domains.
However, despite these dedicated programmes, ministries began submitting project proposals for each sector on an ad-hoc basis, and this trend intensified in recent years.
The combination of sector programmes and discrete projects has created a duality in the approach, leading to disruptions in the approval process, according to planning commission officials.
The Revised Annual Development Programme (RADP) in the current fiscal year adopted 19 individual development projects for the Health Services Division with an estimated cost of Tk 268.47 billion.
The Medical Education and Family Welfare Division is also implementing another 15 projects at a total cost of Tk 150.23 billion.
Dr Syed Abdul Hamid, a professor at the Institute of Health Economics under Dhaka University, stressed that financial discipline is crucial in the health sector and a sector-wide programme cannot coexist with some separate projects.
He said the sector programme was introduced to save the costs of offices, vehicles, and other expenses for project directors.
"Despite sector-based planning, expenses for line directors of operational plans (OPs), offices, and vehicles persisted, undermining cost-saving goals. Additionally, similar tasks are duplicated across multiple OPs, while some essential activities are left out," he explained.
Dr Hamid also highlighted that funds for emergency health expenditures, including community clinics, union health centres, and vaccine procurement, remain suspended since July 2024 and should be resumed immediately.
Furthermore, he pointed out that government health allocations have remained stagnant for a decade. He also urged increased funding and improved spending efficiency to ensure better health sector management.
Officials said the health ministry consulted with representatives from the programme's implementing agencies, the planning commission, the Finance Division, the Economic Relations Division (ERD), and key development partners.
The development partners include the World Bank; the Japan International Cooperation Agency (JICA); the Foreign, Commonwealth and Development Office (FCDO); the Swedish International Development Cooperation Agency (SIDA); the United Nations Population Fund (UNFPA); the World Health Organisation (WHO); GAC; GAVI; and the United Nations Children's Fund (UNICEF).
The ministry focused on strategising an exit plan for the programme.
Officials said the Health Services Division was supposed to implement 23 OPs at a combined cost of Tk 664.92 billion, while the Medical Education and Family Welfare Division would implement 15 OPs at an estimated cost of around Tk 396.08 billion.
All the organisations under both divisions were proposed to implement the programme jointly, but the Health Services Division was solely responsible for the approval and revision stages.
The Finance Division recommended recruiting 45,073 personnel to implement the programme, while 19,492 were proposed to be carried over from the 4th programme.
However, the health ministry proposed carrying over all skilled human resources from the previous programme for the next two years and releasing them permanently after completing their tenures.
"The sector programme, despite its broad scope, faces several limitations, including duplication and overlap in activities," said a senior official at the health ministry.
He said there is also a lack of a permanent facility-based structure in the health sector, delayed manpower creation, unfilled posts, and salary inequality due to development partner funding.
Additionally, facilities have been built without coordination, while accountability is unclear, he noted.
He also said activities should be integrated into the regular and permanent structure of health services, moving beyond sector programmes.
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