Experts call for decentralisation of health administration,
its financial authorities

Health experts at a policy dialogue yesterday demanded that the existing administrative and financial authority in the health sector should be decentralized on a priority basis.

They said local elected bodies should be empowered to monitor the process of accountability and also urged upon the policymakers to encourage stakeholder participation wherever possible.

The dialogue was arranged to review a policy brief on 'Health and Population Sector Policy'.

More than 80 participants from diverse professional groups, which included former health officials, government officials, representatives of donors, UN agencies and civil society, attended the discussion jointly organised by the Centre for Policy Dialogue (CPD), The Daily Star and the Prothom Alo as part of the three-day 'Election 2001: National Policy Forum' at the National Press Club.

Former Health Secretary Syed Alamgir Farrouk presided over the session. Brig (Retd) M A Malek, Advisor for Health and Family Welfare and Religious Affairs of the caretaker government was Chief Guest. The Daily Star Editor Mahfuz Anam was also present at the dialogue.

Dr Noushad Faiz of CPD and Ataharul Islam of presented papers on the draft copy of the Health and Population Policy prepared by the task force.

The speakers put emphasis on amending many of the existing laws and called for formulating separate health legislation. They said that without enacting new laws and having separate health legislation it wouldn't be possible to develop the sector.

Brig (retd) Malek in his speech claimed that whatever resources the government allocates for healthcare ware adequate for it to function properly.

Referring to some specific areas where he thinks improvement was possible, Brig Malek said that all the specialised hospitals in the country must immediately come under autonomy and they should also have the authority to recruit and dismiss personnel. "Unless that happens we cannot demand accountability," he said.

He also stressed on proper utilisation of trained manpower.

"A lot of trained people in this sector have been misused. So I urge you to focus on designating them to the right places where they can properly use the lessons they have learnt in training.

"We must also have a career planning or develop manpower according to our needs. But this must be done through a joint effort. The government alone cannot do this. Bangladesh College of Physicians, Bangladesh Medical and Dental Council and other specialised hospitals must put their brains together to plan proper development of manpower in the country."

Alamgir Farrouk, questioned the allocation and spending process: "How can we ask for more funds when we are unable to spend the money given to us?"

Citing examples, Farrouk said, "Last year we surrendered about Tk 20 crore to the Finance Ministry from our revenue budget and this year, I believe the Ministry would have to part with Tk 30 crore. We had Tk 1.5 crore for repairing expenses of ambulances but not a single penny was spent from the allocated fund.

"The money could not be exhausted, as I understand, due to bureaucratic wrangles in the Health Ministry and the Health Directorate. What I am trying to say is that we don't need more funds to bring about a drastic change in the health sector. The existing budget, I confidently say, is sufficient if utilised in a planned and efficient manner.

"You may say that it's easy for me to express all these things now as I am no longer in the office. But when I was a Secretary I was confined by certain rules and laws. I guess, it is about time that we raise our voice in favour of changing the laws which are creating big obstacles."

Talking on the proposed user-fee, he said that the national Institute of Cardiovascular Diseases (NICVD) already collects it, but it is completely illegal.

"But I support their action anyway simply because the money generated is being used to provide quality service."

"We had agreed to introduce user-fee for healthcare in the country. The Finance Secretary and I had met to discuss the matter and approved the proposal. It is very unfortunate that eight months have passed since, but the official order is yet to be issued."

AKM Shamsuddin, former President of Foreign Investors Chamber of Commerce said, "The state owned enterprises get subsidy worth over Tk 12,000 crore annually. In my estimation each upazila health complex would receive Tk 200 crore annually if we could evenly distribute this subsidy money."

"We need to introduce health insurance system. Health is a matter of the local government. If we want real decentralisation, we must give the local elected bodies autonomy and allow the union council to supervise the issue of accountability. Side by side the secondary and tertiary level hospitals should be privatised."

Dr Naila K Zaman, a leading Child Health Specialist, in her speech said, "The Task Force report reflects what the common people wants and it is very well compiled."

Dr Zaman raised serious concerns about the poor who are finding it increasingly difficult to afford minimum healthcare.

"We must give priority on integrating poverty alleviation with healthcare system. We really do not address those who fall in the category of extremely poor when formulating policies."

"My second concern is politicisation of professional bodies in the health sector. I think the political parties should have a political will. We must decide whether we are going to allow politicisation of our professional bodies or not."

She also strongly recommended that local bodies be empowered so that stakeholders in the localities can demand accountability.

Dr Md Sharfuddin Ahmed, a Bangladesh Medical Association (BMA) leader, called for a bigger budget for improvement in the sector.

Comparing allocation of public spending in the neighboring countries he said that still spends about three dollars per person a year while the amount in other countryies of is roughly twelve dollars.

Prof Mahmudur Rahman, Coordinator of Dhaka Community Hospital said, " None of the union chairmen we talked to know about the $3.2 billion Health and Population Sector Programme (HPSP). Many vital decisions have remained confined inside the Ministries. They are only in papers and have never been implemented since the HPSP was launched in July 1998."

Prof Rahman also questioned the role of the foreign consultants.

"We take foreign consultants too seriously. How much do they know about our economy and who evaluates their reports? Do we at all need the consultants? How are they being selected?"

Dr Quamrul Hasan Khan of BMA was worried about transparency in the HPSP activities.

He asked whether most health professionals were aware of how and why HPSP was designed.

"We have no clear idea how this programme came into being. We have little knowledge about how Tk 15,000 crore would be spent."

Dr Ahmed Al Kabir of Urban Family Health Partnership (UFHP) strongly recommended the involvement of private sector for utilising the existing family welfare staff at the grassroots level.

He proposed developing a mid-wife cadre and train them through private initiative.

Regarding family planning, Dr Kabir said that the expertise of family planning couldn't be ignored while introducing Essential Service Package (ESP).

"Any one thinking of sidetracking family planning and taking ESP would be wrong. Family programme should still be a parallel programme of the government.