They said the Health Ministry, which has long been manifesting poor performance in utilising the budgetary allocation, should now first identify the areas of expenditure and the demands of the health sector based on priorities, for an upgrade to the country’s healthcare services - this process must commence even as the country struggles with the current coronavirus epidemic.

With around 60 percent of the population still living in rural areas, the experienced healthcare sector analysts said a good portion of the budgetary allocation should be spent not only on making the upazila health complexes functional again, but also strengthening them. 

The entire chain along which public health is rendered right down to the point-of-care, should be upgraded including health centres, sub-centres and community clinics, for ensuring greater coverage of the population.

Talking to UNB, former World Health Organisation (WHO) Regional Advisor Muzaherul Huq, former director (disease control) of DGHS Be-Nazir Ahmed, the noted economist and presently visiting professor at BRAC University’s Business School Mirza Azizul Islam, and Distinguished Fellow at leading think tank Centre for Policy Dialogue, or CPD, Prof Mustafizur Rahman also said strong monitoring and a reform in the health sector are imperative for checking misuses and leakages of funds since the sector is riddled with widespread corruption.

Earlier on Thursday, Finance Minister AHM Mustafa Kamal proposed an allocation of Tk29,247 crore for the health sector, up by 23.44 percent from last year’s revised allocation.

As 13 ministries and divisions are currently implementing programmes related to health and family welfare, the minister said as much as Tk41,027 crore has been allocated for the public health sector for the next fiscal year, which is 1.3 percent of the GDP and 7.2 percent of the total budget

He also proposed Tk 10,000 crore to fulfil the emergency requirements to combat the Covid-19 pandemic.

Talking to UNB, Dr Muzaherul Huq said it is a positive side that the allocation for the health sector has increased substantially after a long time along with a bulk amount of Tk 10,000 crore to deal with the Covid-19 pandemic.

“The challenge being posed at the outset from within academia - medical studies departments at public universities or medical colleges - to spend the money in a planned way as there are serious weaknesses in the Health Ministry and the Directorate General of Health Service (DGHS), including an inability to plan and execute needed interventions,” he said.

Prof Huq, also said it is now imperative to work out effective plans in consultation with the experts to spend the Tk 10,000 crores for overcoming the coronavirus crisis. He believes the needs and demands of the health sector should be identified and prioritised accordingly in the light of pandemic.

Additionally, he said an effective referral system with health cards for every citizen should be introduced in the rural areas. “If we can do it, people from rural areas will get access to the health establishments in the public sector after being referred by their local doctors,” Prof Huq said. 

To face coronavirus situation, he said isolation centres can be set up at every upazila health complex with sufficient oxygen supply, oxygen masks, trained nurses and doctors.

Besides, he said steps should be taken for procuring ambulances with modern facilities for every upazila health complex, so that critical patients can be at least shifted to district-level hospitals on emergency basis.

Prof Huq said every district hospital should have three ICU beds per 100,000 of population, complete with central oxygen system and ventilators.

As the health sector grapples with rampant corruption, he said whenever any allegation of corruption will be raised against anyone, it should be investigated objectively by Anti Corruption Commission and exemplary punishment must be ensured if found guilty. 

Dr Be-Nazir Ahmed, one of the most prominent critics of the government response in the days leading up to the budget, expressed his satisfaction with the allocation aiming to overhaul the health sector, terming it ‘impressive’. 

“But it won’t be meaningful without proper implementation. There has to be some goals and plans for better use of the budgetary allocation,” Dr Be-nazir added. 

He said some preventative and some curative steps should be taken to eliminating the coronavirus and ensuring proper treatment for people.

The health expert said effective preventive measures should get the highest priority in spending the Tk10,000 crore set aside to overcome the Corona crisis. “We’ll have to implement the red, yellow, and green zone concept as part of preventive measures. It’ll help us eliminate the virus with a minimum expenditure.”

As part of curative steps, he said all the upazila and district hospitals should be equipped with necessary facilities and machinery and human resources to reduce the corona fatalities.

“Oxygen is necessary for protecting the critical patients. So steps should be taken for establishing central oxygen plants at all the district hospitals and it’s possible to do this in just a month. If we can do it, we’ll be able to reduce the deaths from coronavirus significantly,” he observed.

Mirza Azizul Islam said there is no specific guideline or programme with itemised projects outlined in the proposed budget as to how the Tk 41,000-plus crore allocation would actually be spent, leaving scope for the Health Ministry to chalk out an appropriate vision underpinned by a plan for the overhaul of the vital sector. 

“I think the Health Ministry should now work out well-thought-out plans to ensure best use of the budgetary allocation to get rid of the coronavirus and upgrade the health sector,” he said.

Dr Mirza, who presented the national budget as adviser on the Finance Ministry to the last caretaker government (2007-8), said the Health Ministry should focus on procuring equipment to set up central oxygen system at the government hospitals, to enhance ICU beds, build up a stock of ventilators, and other medical equipment. 

Money would also have to be allocated for building the physical infrastructure, like new medical colleges and increasing capacity at different hospitals.

He also said sufficient human resources, including doctors, nurses, and medical technologists, should be appointed to ensure better treatment at the government hospitals.

“Those who will be involved in spending the money must be made accountable and corruption should be checked for ensuring the proper use of the budgetary allocation for the sector,” he added.