Raising budgetary allocation for healthcare

The demand for raising allocation for the health sector under the forthcoming fiscal's national budget, has been voiced by experts in the relevant field. Surely it merits attention, considering the fact that the health budget in Bangladesh has never exceeded 1.0 per cent of its gross domestic product (GDP). Health activists have thus pleaded for, at least, 3.0 per cent of the aggregate budgetary allocation for fiscal year (FY) 2015-16 for the health sector to match the global standards. Without it, they fear that effective coverage under public healthcare facilities would be too difficult to expand. However, it must be also noted that mere increased budgetary allocation would hardly make any difference to the effectiveness of public healthcare services, without improving governance in health sector, strengthening its management and putting in place a proper monitoring and supervision arrangement.
The present fiscal management system in the health sector is outmoded; it needs deep-seated reforms for better service delivery. The country's existing hospitals cannot even properly spend their earnings from lab charge, seat rent, ticket fee and procedural charge. Furthermore, the attendance of doctors and other members of health staff in public sector service outlets is mostly irregular. There is also a gross mismatch between the health manpower and the required mix in order to make the optimum use of various existing facilities.
In this context, health rights activists and experts have sought increased allocation for the sector under the forthcoming national budget to address basic health concerns of the people at the grassroots. The FE reported last Saturday their demand, coupled with a number of others, that mostly concern improvements of skill and governance as well as changing of financial rules for better medicare-related service delivery. The report also quoted experts as pointing out that a rise in health budget alone will not serve the cause of better health as it is likely to be eaten up by the new hike in salaries and other fringe benefits of health personnel in government hospitals, clinics and health centres. Core healthcare programmes, as they have noted, will require more resources for execution.
It is time for the government to make adequate budgetary allocation, keeping in view the goal of universal health coverage (UHC) to which Bangladesh is committed. Under the UHC programme, people are expected to have access to the needed quality healthcare services without any financial hardship. Although the country has been moving ahead in expanding the healthcare infrastructure to make services available to the people, there are still wide-ranging disparities in accessing services by various groups.
The country's annual per capita health expenditure is estimated at $27. Of this, 64 per cent of the amount comes from individual pockets. Such a situation has a serious effect on the impoverished households of the poor. Bangladesh is also witnessing an epidemiological shift in disease burden. But infectious diseases are taking a back seat and chronic diseases are coming up. The country's health system is not apparently ready for this shift. This will make healthcare more costly for most people. Unless the authorities take a realistic approach to addressing this situation, it will pose a serious challenge for the people at large. For the government to redeem its pledge to provide universal healthcare and to ensure efficient and effective services, all programmes that are relevant to the UHC must be accompanied with a strong political commitment. Without such commitment, the quality of public healthcare services will hardly improve. Transparency and accountability in the health sector will then also be utterly missing.