Health is one of the important human basic rights and universally declared index of human development. Development of health sector not only promotes economic progress, but also ensures the quality of human life as well as social progress. So, it is the responsibility of the state to provide quality health services to all the people.
We have to focus on attaining SDG-3 which promotes the health sector, to ensure good health to people. The SDG calls for ensuring better health so that people can lead a healthy life of. Though health is one of the basic rights of people, universal health coverage is yet to be ensured in the country. A number of problems have been prevailing in the sector those stifle ensuring better health services.
There are a number of problems regarding implementation of health related policy and attaining health related SDG goal in the country’s health system: inadequate budget, grafting, reduction in amount of overseas assistance, lack of financial accountability and time-befitting development plan and implementation process, and non-availability of skilled human resources. It also includes skilled and experienced manpower crisis, regional disparity, scarcity of infrastructure and modern equipment. Unequal financial allocation led to regional disparity regarding health services distribution, which created obstacle to improvement of life of people.
Analyzing some previous budget regarding allocation to the health sector, it is seen that there was no increase in allocation in budget. In 2009 fiscal year, allocation in health sector was 5.7 per cent of our total budget, while it came down to 4.5 per cent in 2015 fiscal year.
In Bangladesh, it is a matter of concern that allocation in health sector decreased compared to target in the 6th fifth year plan, which indicated inadequacy in the allocation. In 2018-19 fiscal year, Tk 23,393 crore (5.03 per cent of total allocation) has been allocated in the budget for health sector while the WHO suggests for allocating 15 per cent of total budget in health sector. It is regrettable that the allocation in health sector has been remained neglected for last 12 years.
In Bangladesh, about 40 lakh people are falling below poverty line every year due to health related expenditure. As per international standard, per capita allocation on health (government, private and personal) remains very low in Bangladesh. It is 32 dollars in Bangladesh. But per capita allocation on health is 61 dollars in India, 39 dollars in Nepal, 111 dollars in Vietnam, 720s dollar in Maldives, and about 1000 dollars in Sri Lanka.
However, out of pocket expenditure in Bangladesh is 63.3 per cent, which is very high. In India, it is 57.3 per cent and 49.2 per cent in Nepal. Several issues such as tendency to earn profit in health sector by commercial institutions, taking increased fees from patients and lack of government monitoring complicated the existing problems in the sector. Such situation resulted in more sufferings for the patients.
Rights activists working in the sector think that whatever may be the allocation, its implementation is very tough in our country. There is poor performance in utilising the allocated money. Due to delay in releasing the budget money, a hurried tendency of misuse of funds is found at the end of fiscal year.
Our health sector is suffering from anomalies like, mismanagement, and misuse of funds. There is manpower crisis, and lack of modern equipment and adequate allocation at the same time. There is discrimination regarding availability of quality health services outside Dhaka as there are vacancy of posts at government health institutions there. Vacancies for post of physicians also remain at the Health Ministry.
As per the recommendations of World Health Organization (WHO), there should be four nurses along with a physician, while doctor-nurse ratio is 1.2 in Bangladesh. According to Bangladesh Health Facility Survey (2014), there is more vacant post of specialist doctors at district and upazila levels. Similarly, there is scarcity of essential services and equipment for providing services to patients at upazila health centre. Unused equipments have been piled up at government hospitals while scarcity of other equipments and materials is sky high.
According to a study of World Bank, 42 per cent medical equipment is kept intact. Lack of manpower and unplanned purchasing of medical equipment and corruption are blamed for the problem. In our country, budget formulation process is completely centrally managed. There is no scope of taking local people’s expectations, needs and trend of disease into consideration while making the allocation.
Health budget for upazila is fixed as per the directive of Health Directorate. The directorate or the concerned ministry takes decision on expenditure. There is no scope of reflecting the needs of local people in the process. Regarding upazila level health budget, it is seen that 52 per cent is allocated for salary of officers-employees, 37 per cent for allowance and 11 per cent for supply and service sector. Food supply is the main sector of expenditure here. Hence, there is limited scope of locally solving any problem if trouble ensues in any matter.
The rights activists, working at the health sector, demanded adequate allocation in health budget taking the matter of public health into consideration. Along with increased budget, they also demanded removing bureaucratic complexity regarding the release of allocated money. They called for ensuring adequate allocation in the health sector by equally giving importance to curative and preventive issues.
To overcome the difficulties in our health sector, we can utilize alternative system of treatment, such as Unani, Ayurveda and homeopathy. We can use the system, which is approved by WHO, also to provide health services to the people. Many countries in the world got benefits through using the system, which can easily be available because of its comparatively lower cost. From the above mentioned example of hybrid model of medical system our government can rearrange the medical sector.
It is hoped that the authorities would come up with specific decision on the issue along with increased allocation for the health sector. Otherwise, people will suffer continuously which will ultimately hamper the economic development of the country.