The government should increase budgetary allocation for the health sector to face the challenges of Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) and to ensure proper healthcare services for the poor both in the rural and urban areas, according to experts.
Placing the national budget of a Tk 523,190 crore (Tk 5.23 trillion) in the national parliament on Thursday, Finance Minister AHM Mustafa Kamal proposed to allocate Tk 25,733 crore for the Health Services Division, and the Health Education and Family Welfare Division.A total of Tk 23,383 crore was proposed for the health sector in the 2018-19 fiscal year while the revised budget is Tk 22,340 crore for the same fiscal.
Besides, the finance minister proposed Tk 3,732 crore allocation for health programmes which will be run by 12 other ministries and divisions. “Currently, 12 ministries and divisions are implementing programmes related to health and family welfare. The allocation for this purpose in FY 2019-20 is Tk 29,464 crore, which is 1.02 percent of GDP and 5.63 percent of total budget allocations,” he said.
Experts said though the proposed health budget is Tk 2,350 crore more than the proposed health budget of fiscal 2018-19 but the allocation is not sufficient to achieve Universal Health Coverage in line with the Sustainable Development Goals.
They, however, termed the year-on-year increase in health budget as positive.
Health economics experts said Bangladesh’s health budget has always been much lower than the 15 percent budgetary allocation recommended by the World Health Organisation (WHO).
In his reaction to the proposed health budget, Dr Kamrul Hasan Khan, former vice-chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU), told the daily sun the health sector should get 10 percent of the total national budget to fulfill demand of the health sector.“We are pushing for increasing the allocation for health sector in the budget. At the same time, the budget allocation should be properly utilised and strong monitoring and supervision should be ensured. Funds should be released on time and corruption must be checked,” Kamrul Hasan Khan said.
Dr Ehteshamul Haque Chowdhury, secretary general of Bangladesh Medical Association (BMA), told the daily sun that “the proposed health budget for FY 2019-20 is not enough to cater to the needs of the health sector. The allocation didn’t increase in proportion with the size of the national budget.”
Referring to the World Health Organisation (WHO) requirement of allocating minimum 5 percent of the GDP for the health sector, he said sadly the country’s health budget remains within one percent of the GDP, which was not ideal to ensure the Universal Health Coverage.
“The budgetary allocation for the health sector should be increased to achieve Sustainable Development Goal (SDG), to reduce Out of Pocket Expenditure and to ensure health services for poor people,” Ehteshamul Haque Chowdhury said.
He said setting up more medical colleges and hospitals and necessary logistics support to run the hospitals was a must, but this required a significant increase in the budgetary allocation.
Professor Dr. Syed Abdul Hamid, former director of Institute of Health Economics (IHE) of Dhaka University, said the proposed allocation of Tk 25,733 crore for the health sector is not enough to meet the needs of the country’s growing population.
“It is not adequate for stepping toward achieving the Sustainable Development Goal (SDG) and Universal Health Coverage by 2030. Though the budget proposal apparently shows a hike in allocation for health sector, this is not a hike in a real sense. Less priority has been given for health sector,” he said.
“Insufficient budgetary allocations for the health sector will accelerate the out-of-pocket expenditure. The out-of-pocket (OOP) health expenditure in Bangladesh is around 67 percent of the total health spending, which is much higher than that of the world average,” Prof Hamid said. According to National Health Account reports, every year the OOP health expenditure pushes four to five million people into poverty, while many of the poor fail to afford minimum healthcare.
Mentioning that the proposed health budget is 4.91 percent of the total national budget, Syed Abdul Hamid said there is no notable change in the proposed health budget for 2019-20 as it was 5.04 percent of the total national budget in last fiscal year 2018-19.
"We have huge challenges for attaining UHC and health goal of SDGs. The proposed health budget didn't reflect enough investment for needed to face the challenges. It is a routine budget and has no particular guideline to achieve these goals," he said.
The Prof. Hamid further said though the proposed health budget shows little bit increase than the last fiscal year health budget, but the extra amount of allocation will basically be used in inflationary adjustment and paying the increment salary and allowance of the employees of the health sector.
"As a result, the allocation of proposed health budget cannot play due role in facing challenges of the health sector," he added.
Syed Abdul Hamid proposed increasing the budgetary allocation for the health sector.