Plan to assess health sector weakness in crash programme

The government is going to undertake a month-long crash programme in the next fiscal year to ensure timely implementation of projects and prevent anomalies in purchases for the sustainable development of the health sector.

As part of this initiative, the government will train Health Services Division officials involved with project execution and assess the quality of all government hospitals in the country, said officials at the finance and health ministries.

Besides, the authorities will make lists of what kinds of equipment are there and what equipment is needed at the public hospitals, and then procure and distribute equipment as per requirement to curb irregularities in purchases.

Abdur Rouf Talukder, senior secretary at the Finance Division, said officials involved in project implementation and procurements in the health sector lack capacity in management and efficiency.

The crash programme initiated by the government will help to eliminate all grievances within the health sector, he expected.

"Health sector purchases are mainly done considering the supply side. We will try to bring it to the demand side. All hospitals in the country will be assessed and the shortage of equipment will be identified and purchases will be made accordingly, he added."

At a special cabinet meeting chaired by Prime Minister Sheikh Hasina at the Jatiya Sangsad Bhaban on 3 June, the prime minister gave the nod to the proposal of the finance ministry to implement a crash programme soon to ensure quality health services, prevent irregularities in purchases, and address failure to implement projects in the health sector.

Finance Secretary Abdur Rouf Talukder has held several meetings with Health Services Secretary Lokman Hossain Miah to find out ways to assess the health sector and address its weaknesses.

There they decided to provide month-long training on doctors appointed as project directors in the health sector, and all other officials of the health ministry and agencies under it who are involved in purchases, public finance management, procurement, and foreign aided projects.

The move has been taken against the backdrop that although the allocation for the development of the health sector is increased every year, the Health Service Division is not able to spend it. The outbreak of the novel coronavirus last year brought to the fore the fragile state of the health sector in the country.

The health sector has received an allocation of Tk11,979 crore in the annual development programme of the current fiscal budget, but merely 21% of the allocation could be spent at the end of 10 months of the fiscal.

In violation of rules, the government approved two projects jointly funded by the World Bank and the Asian Development Bank last year to procure equipment to fight the pandemic.

The World Bank-funded project came to a halt after major irregularities in procurement were revealed at the outset, and the health ministry could not spend any money on the ADB project. Although adequate funds have been allocated in the budget for the vaccination, the Health Services Division has not yet succeeded in officially importing the vaccine.

Not only opposition parties and civil society, but also cabinet members have been vocal about the irregularities and failures in the health sector.

After a recent meeting of the Cabinet Committee on Public Purchases, Finance Minister AHM Mustafa Kamal also acknowledged the failure of the health ministry.

He said the health ministry had failed to make a proper decision in time.

Foreign Minister AK Abdul Momen also blamed the health ministry's failure for causing delay in vaccine imports from Russia and China.

An official of the Finance Division told The Business Standard that training will start in July at the Public Finance Institute in the capital's Segunbagicha. At the same time, the work of the health sector assessment will also continue.

Mentioning that the Finance Division will not end its responsibility by providing training only, he said in order to improve the quality of the health sector in the long run, project implementation and procurement situations will be monitored. In addition to the necessary co-operation to eliminate long-standing mismanagement, interventions will also be made to bring transparency in the procurement process, he added.

The official further said projects in the health sector are implemented by the Health Division.

"It is physicians who are basically appointed as directors of these projects, but they seriously lack administrative skills.

"Again, they make unnecessary purchases at the beginning for personal benefits. The sector has been going on like this for a long time. There are instructions from the highest level of government to streamline the sector to ensure quality healthcare," the official said.

Dr Syed Abdul Hamid, professor at the Institute of Health Economics, Dhaka University, said the training initiative to improve skills of doctors involved in the implementation of health projects is "very good".

"We have been recommending it for a long time. It is good to hear that the government is walking on the road even though it is late.

"Imparting training on officials only for once will not be enough. These kinds of training have to be done every year because those involved in the implementation of the projects are changed frequently. Besides, it is important for everyone to have refresher training," he said.

Terming the initiative to assess the health sector as "better", Professor Hamid said it should be done on an urgent basis.

He said the assessment will be done only after informing the ministry in a prescribed form what equipment is available in the concerned hospital, which is in operation and which is out of order. No survey or inspection will be required for this. Just a system has to be established.

 "The unscrupulous syndicate in the health sector will not be able to do much, if the equipment are purchased as per requirement assessment and are supplied to the hospitals accordingly. However, this kind of assessment has to be done every year. At the same time, attention should be given to making sure that hospitals use the equipment to ensure services to patients," he concluded.