Govt plans increased funding for healthcare, aims to improve quality, accessibility

The government has planned to spend Tk1 lakh crore in the next five years under a multi-lenders-aided project to expand universal health coverage and lower the cost of treatment people pay from their own pockets.

The outlay for the fifth phase of the Health, Population and Nutrition Sector Programme (5th HPNSP) is 53% higher than the forth version ending this June.

Due to lower public expenditure in health sector, Bangladeshis are required to pay more than two-thirds of their treatment cost out of their own pockets, a health ministry report said last year.

In the 5th HPNSP, adequate attention will be given to the wider primary health coverage, prevention of diseases and promotion of a healthy lifestyle which are expected to lower people's out-of-pocket healthcare spending, according to officials at the Directorate General of Health Services and the Economic Relations Division (ERD). 

To achieve these goals, the support systems for primary healthcare services will be reinvigorated by improving facility readiness, enhancing the capacities of the healthcare workforce, implementing the essential services package without imposing financial hardship on patients, and fostering better coordination among stakeholders, they said.  

The 5th HPNSP, beginning in July, will also address emerging and recurring disease burdens, the officials said.

It aims to expand coverage, improve access to, and increase utilisation of quality primary healthcare services in both rural and urban areas within five years from July.

The government is trying to secure $2.31 billion in foreign assistance to meet about 24% of its total expenses for the programme. Development partners have already approved $1.61 billion, equivalent to Tk17,714.70 crore, said officials at the Economic Relations Division (ERD). The rest of the amount — Tk80,685.30 crore or 76% of the total expenses — will be financed by the government.

The fifth phase will run till June 2029 and will move forward to gradually raising health sector allocation to 2% of gross domestic product (GDP), which is less than 1% for the last two decades, officials said.

Health Minister Dr Samanta Lal Sen said, "Primary healthcare and universal health coverage will be our top priority. Besides, we will emphasise prevention of maternal and child mortality."

"We will work from the first day of the 5th HPNSP so that we can spend the allocated money in the programme properly," the minister told The Business Standard.

The share of out-of-pocket health expenditure, the amount people spend from their pockets for diagnosis, treatment and medicines, was around 69% in 2020, up from 56% in 1997, according to the sixth Bangladesh National Health Accounts published by Health Economics Unit of the health ministry last year.    

According to the Health Economics Unit, the rate of out-of-pocket expenditure in the country was quite high compared to the world perspective.

Health experts feel the achievements of the next phase of HPNSP will depend on its proper implementation.   

"The key question is how efficiently the proposed allocation will be spent. If it is not spent properly or if it does not yield the desired result, then the people will not benefit," Syed Abdul Hamid, professor at the Institute of Health Economics at Dhaka University, told TBS.

"The allocation that is being given should be received by the health sector regularly. Maximum benefit should be obtained from it. Therefore, the regular problems that we hear about in the health sector, such as irregularities in the procurement of equipment, corruption, etc, need to be addressed," said Prof Hamid.

Foreign assistance target 

Approvals have so far been secured from development partners for $1.61 billion, equivalent to Tk17,714.70 crore, said ERD officials. The funding will be provided by development partners in the form of loans and grants, they said.

Of the amount, the officials said, the World Bank has agreed to lend $479 million, the Asian Development Bank (ADB) $500 million and Japan $76.89 million.

The officials said $529.54 million in grant commitments was received from development partners. The Global Financial Fund, ADB, Japan, Global Fund, Sweden, Canada, Unicef, Gavi, UNFPA and World Health Organization will contribute to the funds.

The government is in discussions with the Asian Infrastructure Investment Bank (AIIB), South Korea, and China to secure $700 million in additional funding to bridge the financing gap, the officials said.

If a positive response is not forthcoming from these development partners, the government will seek supplementary funding from the World Bank, Gavi, the Global Fund, and the ADB, they said.

Improving quality and efficiency of health services to be prioritised

The Directorate General of Health Services has already submitted the proposals for the 5th HPNSP to the Planning Commission for approval, aiming to initiate implementation activities by July.

The allocation to the health sector, the officials said, has been increased in line with the Eighth Five-Year Plan's objective of raising the sector's allocation to 2% of GDP.

The government has been implementing the HPNSP since 1998. While administrative expenses were included in the previous four programmes, they are not included in the proposed 5th HPNSP, they said.

Improving the quality and efficiency of health services across different levels of hospital facilities will be prioritised in the 5th HPNSP, said the officials. This will include the secondary and tertiary level facilities and specialised institutions, they said. 

It will also include developing agreed and cost-effective protocols for treating diseases, and setting up standards and measures for infection control, said the officials. An appropriate medical waste management system will be established at these facilities for ensuring health and environmental safety, they said.

The 5th HPNSP will be responsive towards the changing epidemiological transition towards non-communicable disease control and mental health issues, said the officials. Comprehensive geriatric care will be introduced, and mental health services will be strengthened at all tiers of facilities, they said. 

Extensive efforts will be taken to raise awareness of life-style choices and food habits, etc, said the officials. The 5 HPNSP will continue to address the issues relating to high maternal and newborn mortality, they said.

"It's commendable that this programme prioritises urban health. However, the health ministry should not establish its own facilities in Dhaka, as there are already numerous private hospitals in the city. Instead, the ministry should develop a standard operating procedure and procure services from the private sector based on the procedure," said Prof Hamid.

This approach, he said, should not be limited to primary healthcare in urban areas. The government should also purchase specialised services like cancer and dialysis care from the private sector, as these are not fully available in public facilities, he added. 

The Primary Healthcare Department within the Directorate General of Health Services can be responsible for procuring these services, said Prof Hamid.

"Instead of having separate departments for primary healthcare, cancer, and dialysis care, it would be more efficient to establish a single 'national health protection authority.' This would minimise wastage of funds and enable a more streamlined approach to healthcare delivery," he said.