Why we need an ‘emergency response programme’ in the health sector
An 'emergency response programme' would facilitate financing for all types of health-related emergency situations, including those arising within hospitals
The health sector often faces various 'emergencies', such as global pandemics like Covid-19 and endemics like dengue, chikungunya, or diarrhoea. Floods, cyclones, and tidal surges also give rise to health emergencies.
Moreover, we encounter health emergencies caused by significant fires; building collapse and fire, launch-capsize or bus-rail accidents. Given the diversity in the types of these emergencies, there are also variations in their magnitudes.
Likewise, the management strategies for each type of emergency differ. While dengue is a recurring disease, it escalated into an endemic level this year. The catastrophic floods in Sylhet necessitated emergency healthcare last year. Similarly, this year, there was a significant outbreak of diarrhoea at the beginning of summer.
Occasionally, critical medical equipment in hospitals becomes inoperable, disrupting vital healthcare services. For instance, recently, the CT scan machine at Dhaka Medical College Hospital malfunctioned, disrupting essential healthcare delivery.
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Consequently, dealing with all these emergency scenarios requires well-trained and skilled personnel with the necessary tools. On the other hand, easily accessible funding is crucial.
It should be noted that within Bangladesh's health sector, apart from the line-item-based 'operational' budget, there exists a flexible financing system known as the 'Operation Plan' under the five-year plan for various developmental activities. This framework allows for budget allocation as a 'lump sum' and permits the use of allocated funds in subsequent years within a five-year timeframe if they cannot be expended in a particular year.
However, if the allocation from the operational budget remains unspent by June, there is no provision to carry it over to the following year. Since predicting the nature and severity of future emergencies is challenging, allocating funds in advance within the line-item-based operating budget to address 'emergency conditions' is not feasible. As a result, these emergencies cannot be effectively managed without a dedicated programme supported by flexible financing.
However, given the absence of such a dedicated programme, when an 'emergency situation' arises, the relevant department must grapple with dire circumstances to manage it. The lack of such a system resulted in significant challenges during the early days of the Covid-19 pandemic. Ultimately, we had to seek assistance from various development partners, including the World Bank, Asian Development Bank, and USAID. This approach is not ideal for a nation aiming to achieve middle-income status. It is a known fact that the funds received from development partners come with conditions attached.
Thus, during the Covid-19 period, we proposed the establishment of an "Emergency Response Programme." We had hoped that this proposal would find a place in the 'Strategic Investment Plan' crafted for the health sector's fifth five-year plan. Regrettably, this concept was not incorporated into the 'Strategic Investment Plan'. Currently, the preparation of the 'Operation Plan' is underway and is in its final stages. However, no indication has been provided regarding the creation of an 'Operation Plan' to address 'emergency situations'.
This year's dengue endemic serves as a stark reminder of the significance of an "Emergency Response Programme." Dengue is claiming lives every day. According to government statistics, the death toll as of August 14th stood at 414, with the overwhelming majority of infections occurring in July and August. The daily death toll remains above ten. This severe dengue outbreak may persist until October. With cases increasing steadily, it would not be surprising if the death toll exceeded 1,000 or more.
This year, the death rate among dengue patients is nearly seven times higher than that in 2019. Approximately 70% of the victims are under the age of 30, and 80% are under 40. This demographic includes government employees, businessmen, doctors, engineers, and working individuals. It appears that no one is immune to dengue's impact. The loss of these lives shatters the dreams and hopes of their families. However, are we not concerned about this situation?
Due to financial constraints, the Directorate General of Health Services (DGHS) seems helpless in effectively controlling and managing dengue cases. An emergency response programme is imperative to alleviate this helplessness.
Therefore, we implore the policymakers in the health sector, particularly the Director General of Health Services, the Secretary of the Health Services Division, the Minister of MOHFW, and ultimately the Hon'ble Prime Minister, to introduce an 'Emergency Response Programme' within the health sector. This programme would facilitate financing for all types of health-related 'emergency situations', including those arising within hospitals.
Dr Syed Abdul Hamid is Professor, Institute of Health Economics, University of Dhaka.
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.
