On a recent webinar, organized jointly by Bangladesh Health Watch and Unnayan Shamannay on Saturday, 12th May, different health sector-related issues came to light which needs to be addressed in this coming budget. 

Among honorable Parliamentarians- Dr. Samil Uddin Ahmed Shimul (Chapai Nawabganj-1), Dr. Habibe Millat (Sirajganj-2), Dr. Pran Gopal Dutta (Comilla-7), Dr. A. F. M. Ruhal Haque, MP (Satkhira-3), Dr. Md. Abdul Aziz (Sirajganj-3), and honorable State Minister for the Ministry of Disaster Management and Relief- Dr. Md. Enamur Rahman (Dhaka-19) were present as discussants. Expert panelists at the online session were- Dr. Mushtaque Raza Chowdhury (Convener, Bangladesh Health Watch), Dr. S. M. Zulfiqar Ali (Senior Research Fellow, BIDS), and Dr. Syed Abdul Hamid (Professor, Dhaka University). Unnayan Shamannay Chair and former Governor of Bangladesh Bank- Professor Dr. Atiur Rahman presented the keynote paper, while Bangladesh Health Watch Budget Thematic Group Chair- Professor Dr. Rumana Haque moderated the session. 

The discussion however reflects it is most likely that the national budget for the upcoming FY 2022-23 is going to be a slightly contractionary one given the existing geopolitical situation and economic realities and potentials of the country. However, any curtailing in the allocations for health sector will not be appropriate. Rather, allocations for this sector need to be further increased and of that increased allocation the largest share should be secured for primary healthcare. 

Recently, publicized sixth report of the Bangladesh National Health Accounts (BNHA) says that of the total health expenditure in Bangladesh, 68 percent is coming out of the pockets of the citizens. 23 percent of that is borne by the government. The burden of out-of-pocket health expenditure on citizen can be reduced to a significant extent if public expenditure on primary healthcare can be increased. 

While presenting the keynote paper- Dr. Atiur urged to come out the practice of allocating 5 to 6 percent of the total national budget for health sector. He also pointed out that usually 25 percent of the health sector allocations go for primary healthcare. This should be increased to 30 percent in the coming fiscal year and increased to 35-40 percent within the medium term. Dr. Atiur further added that if the allocations for providing free-of-cost medicine for the people can be tripled then the out-of-pocket health expenditure can be reduced from 68 percent to 58 percent. Dr. Ahmed Mushtaque Raza Chowdhury suggested to establish a national commission to ensure quality primary healthcare. 

Dr. S. M. Zulfiqar Ali,  stating that the income-poor segments of Bangladesh’s population is being forced to spend 33 percent of their income for healthcare, emphasized on developing a health insurance program for these people. He said, “’Health Shock’ (high health expenditure) is a burden for marginalized population”. Therefore, it is hight time we should start health commission, health insurance and a collaboration with government, private and NGO partnership.”

Honorable State Minister for the Ministry of Disaster Management and Relief- Dr. Md. Enamur Rahman pointed out that the Government’s commitment to ensure quality healthcare for all is reflected through ensuring COVID-19 vaccination for 80 percent of the population within a short time. He believes if this efficiency can be replicated across the entire health sector, then it will be possible to ensure quality healthcare for all in the country.  

 Former health minister Dr. Ruhal Haque and Dr. Habibe Millat emphasized on decentralization of the health sector management to improve service delivery. Both the members of the parliament also emphasized the lack of manpower issue. They said that we need at least 5 lacs doctors to serve the huge population, whereas we have only 1 lac doctors. Though this government speed up the recruitment numbers of doctors through special BCS exams but still the number is not adequate . 

 Md. Abdul Aziz, who is a member of the parliamentary standing committee on health and family welfare, emphasized on ensuring adequate services at the 493 Upazila Health Complexes across the country. He believes instead of trying to improve conditions of all these healthcare centers at once, government needs to take a ‘step by step’ approach. 

Dr. Pran Gopal Dutta, in his remarks, highlighted- the need to enhance capacity of the drug administration to ensure quality control of the medicine that are sold in the local markets and the need to allocate budget for universal health insurance.

Prominent health expert activist Dr Zafrullah Chowdhury suggested making all the medical equipment Vat and Tax free so that the out of pocket expenditure may be reduced a bit. 

On this discussion, all the members strongly emphasized on three key issue, i)forming health commission, ii)health insurance for all and iii) increasing health budget allocation. 

Government and non-government stakeholders related to healthcare, media professionals and civil society representatives participated in the online discussion session. 
 
The event got a good number of media attention and therefore 24 media outlets have published the report. 

Recorded version of this event can be found here.

Event Video: