National Health Budget: PerspectiveHealth Rights

1
National Health Budget Perspective-Health Rights

• Discussion Meeting
• 01 June 2006, National Press Club, Dhaka
• Organized by
• Physicians for Social Responsibility, Bangladesh
  (P.S.R.B)
• Presented By
• Dr. Mohd. Abdul Matin
• Executive Director, Health Research Rights
  Foundation (HRRF)

2
Preliminary Considerations

• Health Curative Preventive
• BackgroundHealth Rights - Patients
• Citizens Health Workers
• View Health Rights Activist
• Basis National Health Budget 2005 - 2006,
• Policy Matters

3
National Budget Health Sector

• Revenue and Development Total allocation Tk.
  4,240 crore
• Last Years allocation Tk. 3,732 crore
• Enhancement Tk. 508 crore or 13.61
• Enhancement Last Year 28

4
Enhancement in Actual

• Price Hike
• New Pay Scale 26.80 on Total Revenue Cost or
  15.78 on Total allocation
• Actual enhancement Zero or less

5
2005-2006 Budget

• Total budgetary allocation Tk. 64,636 crore
  (Revenue Development Tk. 38,082 crore Tk.
  26,554 crore)
• Health Family Planning Tk. 4,240 crore 06.55
  
• HFP allocation last year 06.70
• So actual allocation 2005-2006 0.15 reduced
• Health FP allocation 01 of GDP

6
2005-2006Sector wise review

• Education and Technology 15.00
• Bank Interet Repayment 10.90
• Transport 10.00
• Local Government Rural Development 09.90
• Energy Power 06.70
• Health FP 06.55
• Only Development Budget Tk. 25,273 crore
• H FP Tk. 2,173 crore 08.60 i.e. 6th

7
Per Capita allocation

• Total Population 135 millions
• H FP Budget total Tk. 4,240 crore
• Per Capita F FP allocation Tk. 314.00 or
  04.90 US
• National Health Policy Per head minimum cost 12
  US

8
HFP allocation in last 04 years
2002-03 06.47 2003-04 05.62 2004-05
06.50 2005-06 06.55
9
Common Ideas on Budget

• Just few increases in last years allocation
• Priorities
• Domination of power lobby, Fund availability,
  Project based
• Peoples opinion U real necessity ignored
• But budget means a total economic plan not
  funding alone

10
Health Delivery in Bangladesh

• Curative
• Preventive
• Governmental
• Semi-Governmental
• Private
• NGOs
• Voluntary

11
Present Health Delivery Status

• Current Capacity 40 population can avail
• Common concept Nothing available in Hospitals
• Institutional Delivery Mainly Governmental
• Main Source for poor and middle class
• Rural Hospital Daily average OPD patients 250
• But Indoor widely vacant
• Secondar Hospitals Same
• Tertiary Hospitals Huge Rush

12
Picture of Rural Hospitals 1998 study

• Per Citizen HFP allocation Tk. 01.12 or or
  01.50 cents
• No Ambulance39 hospitals
• Available ambulances 80 out of order or not in
  use
• Devoid of good foods 44 hospitals
• No X-Ray Plant 43 hospitals
• Inadequate Medicines 70 hospitals
• Doctors Posts Vacant 60
• Pathology Inadequate everywhere
• Old Buildings, inadequate power and water supply
• Cleanliness Waste Management Inadequate

13
Health Index in Bangladesh

• Expectant mothers without antenatal Check up 75
• Anaemia in Pregnancy 70 mothers
• Maternal and Child Mortality Highest
• Under Five malnutrition 50
• Dying Patients never saw doctors face 25

14
Public Sector Actions

• Health Reforms Cost in last 08 years Tk. 30,000
  crores
• Success Practically insignificant
• Huge Corruption
• Core Theme Open Market Economy

15
Understanding Open Market

• Change of Concepts Decay in relation
• Patient or Consumer ?
• Doctor or Service Provider ?
• Responsibility of failure - Only Service
  Providers ?
• What about Managers ?
• Health is Commodity

16
Social Factors Ignored

• Preventive Factors
• Environmental Degradation
• Waste Management
• Human Rights Custodial Domestic Torture,
  Prisoners, Women and Children Repression
• Medical Ethics BMDC ?
• Lack of Information on diseases
• Safe Food and Drinks
• Deficiencies - malnutrition
• Organic Agriculture

17
Social Factors Ignored

• Health friendly industrialization and
  Urbanization
• Disaster Management
• Safe Transportation
• Sanitation
• School Health
• Occupational health
• Drug Abuse
• Medical Manpower Disused

18
Mortality in Bangladesh DFID Study 2000

• Environnemental Causes 38.10
• Air Pollution - 17.80
• Water Pollution - 11.00
• Trauma - 09.30

19
Few Positives Gestures

• Addition of Beds in rural and secondary hospitals
• Two new 500 bed hospitals in northern area
• Initiative for recruitment of some doctors
  nurses
• Nutrition Service in 105 rural hospitals
• Extension of tax holidays for private hospitals
• Formulation of National Population Policy
• Sanitation for all by 2010
• No VAT on IV set
• Extension of tax holiday on Poultry feed and
  farms
• Special allocation for acid burnt, disables
  disaster victims

20
Few Good Steps Bad or Good

• Community Clinic Cancelled Political
• Coordination of Health and FP - Cancelled
• Commercialized Drug Policy - preferred

21
Hospital Scenario

• Dirty Environment
• Inadequate water and power supply
• Old technology
• Low quality diets
• Medicinal Drugs Not available
• Manpower inefficient, insincere, ill behaving
• Inadequate Specialists
• Management inefficiency Failures
• Corruption
• State Obligation ?

22
Open Market Luxury

• Open Market Policy in Sevice Sector
• Cost Sharing theory
• Money collection from poor pockets
• No visible health projects (heart, brain, kidney)
  
• No health tax for better steps

23
Medical Education

• Higher Education Lack of transparency, political
  favoritism in admission systems
• Same in Public Service Commission
• Only Medical University full of irregularity and
  anarchy
• Private Medical College Substandard business
• BMDC Inactive for an Era

24
Health Reforms Defective

• HPSP and HNSP more than 10 years
• Aims To improvise current mismanagements only
• Social Factors of Health Denied
• Administrative anarchy, inefficiency, policy
  mistakes, corruption no way out
• Disputed, Defective, No evidence in the world

25
Health Policy Where is it now ?

• Health Policy Expected by all and something
  among nothing
• Weakness Defective health reform as base
• Pragmatic Approach ? Identify needs first, then
  policy.
• Strategy of implementation may be Reform
• Priority Problem the cart before horse
• Governments more interested in reforms than
  policy

26
Budget Preparation

• Health not a priority sector, rather ignored
• 3 years back priority was energy
• Next year Rural population
• Last year Social Sector Election priority
• But health ignored every time
• Peoples Health always ignored
• MDG ?

27
Health Mismanagement Failures

• First Victim Poor
• Next Health professionals
• Management Constraint of policy and reform
• Trapped in corruption and inefficiency
• Health Ensured in national constitution as basic
  citizens right
• Healthy Nation prerequisite for prosperity

28
What to do in Budget ?

• Total allocation for health 15-20
• Health as priority in all sectors
• People oriented financial managements Banking,
  insurance, taxation, industry, trade,
  import-export
• Fund allocation Prioritize public interest
• Curative and Preventive Equally priority
• Environment, Safe food and drinks, waste
  management, human rights, Tobacco control
• Combat Administrative anarchy, political
  favoritism, bureaucracy, corruption lack of
  accountability

29
THANK YOU ALL