Govt spends only $45 per capita on healthcare

The national budget of Bangladesh is swelling every year, but the citizens still shoulder 68 per cent of their healthcare expenses. The country’s Current Health Expenditure (CHE) is only 2.3 per cent of the GDP, lowest among South Asian nations.

Bangladesh government’s CHE spending is only around $45 per capita, compared to $58 in Nepal, $73 in India, $103 in Bhutan, and $157 in Sri Lanka. Moreover, health ministry allocations have been consistently hovering around 6 per cent of the total budget for years.

These findings came from a keynote titled “Budget 2022-23: Expectation of Allocation in Health Sector,” presented by former governor of central bank and president of Unnayan Shamannay Dr Atiur Rahman at a webinar on Thursday.

Bangladesh’s health sector expenditure has been growing at a rate of around 7 per cent in recent years, compared to the country’s average GDP growth of 6 per cent, mentioned the keynote, adding that this increase was significant during FY21 and FY22 – amid the Covid crisis.

Participating at the event, jointly organised by Bangladesh Health Watch, BRAC James P Grant School of Public Health, BRAC University and Unnayan Shamannay, experts and lawmakers said any decrease in the country’s health sector allocations will be inappropriate.

They added that the government should further increase allocations for this particular sector, and of the allocation, the lion’s share should be set aside for providing primary healthcare to citizens.

According to the keynote, of the overall healthcare costs, citizens pay 68 per cent, government pays 23 per cent, development partners pay 5 per cent, non-government organisations pay 2 per cent, and private sector pays 2 per cent.

A citizen spends around 67 per cent of their healthcare expenditure on medicines and other perishable medical products, 13 per cent on outpatient curative services, 8 per cent on inpatient curative services, 7 per cent of laboratory services and 5 per cent on imaging services.

The keynote also reveals that 12 per cent of citizens do not seek out professional medical services after suffering illness or accidents. This figure is 23 per cent in metropolises, 17 per cent in remote areas.

Besides, 17 per cent of the outpatients and 57 per cent of the inpatients go to public hospitals or healthcare centres for treatment.

The government spends 25 per cent of its health sector allocations on primary healthcare, 39 per cent on secondary healthcare, and 36 per cent on tertiary healthcare.

Stating that the majority of people in need of treatment visit health centres for primary healthcare, the study recommended that the particular service be further strengthened.

Of its total healthcare expenditure, the government allocates 13 per cent – 21 per cent on average on medical and surgical treatments, and equipment used in those procedures.

The study suggested further increasing allocation for providing medicine to underprivileged citizens – at subsidised prices or free of costs – to alleviate the burden of their medical costs, as the existing allocation for this segment is not enough.

Each year, around 25 per cent of the health sector allocations go into primary healthcare. This allocation should be increased to 30 per cent in the upcoming FY, and 35 per cent to 40 per cent in the medium term.

“If the allocations for providing free-of-cost medicine to people can be tripled, then the out-of-pocket health expenditure would reduce from the existing 68 per cent to 58 per cent.”

Addressing the webinar, Former health minister Dr AFM Ruhal Haque said, “Bangladesh has only one lakh doctors, but the country needs at least five lakh such professionals.

“Though the incumbent government sped up the recruitment of doctors through special BCS exams, the number is still far from adequate.”

Latest health ministry data reveals that the country has 1,02,997 doctors.

Md Abdul Aziz, a member of the Parliamentary Standing Committee on Health and Family Welfare, said, “I believe that instead of trying to improve conditions of all these healthcare centres at once, the government should take a step by step approach.”

Dr Pran Gopal Dutta, former vice chancellor of the Bangabandhu Sheikh Mujib Medical University Hospital and personal physician of the Prime Minister, said 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.