The economics of health and the health of economics
Allocation to health should be increased, expenditure should be proper, and health protection should be the focus of development
In the financial year 2023–24, an allocation of Tk38,000 crores for the health services division and the health education and family welfare division were made in the national budget. In the financial year before that (2021-2022), the allocation for this sector was Tk36,863 crores. This increase compared to the last budget is 3.22%.
Experts say this increase is a 'bagatelle,' adjusted only for inflation. Rather, spending on the health sector has decreased in terms of sectoral allocation in the total budget. The traditional allocation for the health sector has proven this sector to be insignificant and negligible.
In terms of total allocation, in the last financial year, the allocation for the health sector was 5.4% of the total budget. This time, it was 5%. In other words, the allocation to the health sector has decreased by 4.4% from the point of view of the total budget. Success in achieving the Millennium Development Goals in the health sector has continued efforts to achieve the Sustainable Development Goals, which have been an idle story.
So, the question is whether this budget conforms to formalities and can bring about any immediate changes in the health sector.
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What is allocated in the budget is not implemented normally. It's habit-forming here. Allotment always comes down to the base. Again, a new allotment is given. It goes back again. Thus, the allocation is decreasing every year due to improper implementation of the allocation. But we don't have information about the reasons why it is not being spent.
Does the Ministry of Health not have the ability to manage the costs properly? This information is needed. Allocation to the health sector is given for the construction of health sector infrastructure, the purchase of equipment, and the purchase of medicines. Are we spending money on these? Or, has our goal in the health sector been achieved?
The answer to all is 'no, but why don't we implement the whole allocation? We all want the answer to this question. According to Implementation Monitoring and Evaluation Division (IMED) data, the health department could not spend 29% of the allocation in the previous financial year 2021–22.
The allocation in the budget of this financial year was Tk13,017 crores; the expenditure was Tk10,292 crores. Even during the Corona pandemic, the health sector could not spend all of the allocations. This is depressing information.
During the pandemic, the expenditure allocated in the budget for the financial year 2020–21 decreased further. About 42% of the allocation was returned at this time. In the financial year 2020–21, the allocation was Tk12,989 crores. At that time, the health department spent Tk6, 933 crores.
In the financial year 2019–20, the allocation was Tk7,761 crores. Out of this allocation, Tk5,741 crores were spent. 26.04% of the allocation remained unused.
In the financial year 2018-19, the amount of allocation was low, and the expenditure was also low. According to the information, the allocation in this financial year was Tk8,261 crores. Tk7,334 crores were spent. As such, the rate of unutilised money is 11.22%. The 2022–23 budget allocation for the health sector was 5.4%; in terms of money, it was Tk9,794 crores. Out of this, Tk3,236 crores were spent in the first 10 months of the fiscal year, which is 33% of the total allocation.
According to that, Tk6,558 crores were idle. But before knowing its latest update, the new budget has been announced. Sadly, the allocation to the health sector cannot be implemented. The government allocates money to make the health sector self-reliant. However, the Ministry of Health cannot spend the allocated money! Boo-hoo!!
Does our country not need health care services? Or are the people of our country so economically strong that there is no need for government spending on health care? No, but the coronavirus epidemic has shown the dire condition of the health sector. There is a shortage of doctors, nurses, and technicians in the hospitals in Bangladesh. There are doctors, but not enough skilled technicians, and there are many cardiologists, but no anesthesiologists. There are hospitals with big buildings, but there is no quality treatment.
The budget allocation should have been much more for each district or upazila hospital to have better testing labs, recruitment of manpower, or increased ICU facilities. Besides, the allocation should have been more for drug research and drug imports. The issues of mismanagement during the Corona crisis have become clear. These must be eliminated. There is no change in the main budget for health sector reforms. The entire budget is not spent every year.
According to a 2018 report by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP), in terms of GDP, Bangladesh has the lowest allocation to the health sector among 52 countries in the Asia and Pacific region. Health spending in Bangladesh accounted for 3.4% of gross domestic product (GDP), which is lower than the average (3.8%) in the Southeast Asia region, below the average of low-income countries (5.4%), lower-middle-income countries (4.3%), and far below the world (8.5%).
Among developed countries, New Zealand spends 9% of GDP. The USA spends $12,914 per capita on health, 18.3% of GDP. But in Bangladesh, this rate is around 5%. According to the recommendations of the World Health Organisation, at least 5% of the GDP and 15% of the budget should be allocated to the health sector in a country. All in all, as of recently, the government spends about Tk350 per month on treatment for one person in the country.
Covered in the cloak of corruption, inefficiency, and mismanagement, the sector of public importance has been neglected for a long time, and the level of neglect has increased by reducing the allocation in actual terms.
We cannot build a healthy, strong nation if we do not pay attention to this sector, considering the SDG targets and the needs of the time.
M Jahangir Alam is a Researcher and Development Worker.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
